The Role of Microcirculatory Dysfunction in the Pathophysiology and Treatment of Venous Leg Ulcers

Klonizakis, Markos

doi:10.1001/jamadermatol.2019.0591

Cited by 3 publications

(1 citation statement)

References 6 publications

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“…Although the pathophysiology of the CVI-venous ulcer connection is well-studied, it is incomplete [106]. Altered aspects of the microcirculation are likely involved in this transitional process [107][108][109].…”

Section: And Its Linkage To Venous Leg Ulcers (Vlu)mentioning

confidence: 99%

Chronic Venous Insufficiency With Emphasis on the Geriatric Population

Mayrovitz¹,

Aoki²,

Colón³

2023

Cureus

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The underpinning of Chronic Venous Insufficiency (CVI) is valvular dysfunction, which manifests on a spectrum depending on the severity of insufficiency and duration of the disease. The mainstay of treatment relies on compression therapy of a proper type and intensity. In older adults, special consideration must be taken during the patient encounter to account for age-related factors. This review discusses the clinical presentation, diagnosis, and mimicking of CVI, focusing mainly on older adults. The epidemiology, risk factors, disease burden, and grave complications -such as thrombosis and ulceration, are reviewed. The physiological impacts of CVI are described, providing the background for treatment strategies, including non-invasive, medical, and surgical therapies. The findings show advanced age to be an important risk factor contributing to CVI and that other age-related factors add to the risk of severe complications. Clinical assessments combined with objective measurements that assess localized skin water using tissue dielectric constant values or whole limb assessments may aid in the differential diagnosis. Furthermore, understanding the mechanism of action of compression therapy, the mainstay of CVI treatment, and its physiological impacts, allows for its informed use in geriatric patients with increased risks of potential compression-related side effects.

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Section: And Its Linkage To Venous Leg Ulcers (Vlu)mentioning

confidence: 99%

Chronic Venous Insufficiency With Emphasis on the Geriatric Population

Mayrovitz¹,

Aoki²,

Colón³

2023

Cureus

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Testing the feasibility of a co-designed intervention, comprising self-managed, home-based, exercise training with embedded behavioural support and compression therapy for people with venous leg ulcers receiving treatment at home (FISCU-II)

Klonizakis,

Gumber,

McIntosh

et al. 2023

Clinical and Experimental Dermatology

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Background Venous leg ulcers heal slowly, are painful and costly for healthcare systems, and also affect patients’ quality of life. Previous work suggests that supervised exercise training used in combination with compression therapy may offer clinical benefits. However there is a large population of people with VLUs, who are unable to access such an intervention due to frailty and age. Objective Our primary aim was to assess the feasibility of FISCU Home (a co-designed, 12-week home-based, self-managed, lifestyle programme based on exercise and behaviour support), as an adjunct therapy to compression in people with VLUs. Methods Forty people with VLUs (121 excluded/22 refused), receiving treatment at home, were recruited from community nursing and tissue viability teams and newspaper advertisement. Participants were randomized 1:1 either to exercise with behaviour support (thrice/week) plus compression therapy or compression only. The feasibility of the programme was assessed using progression criteria that included exercise attendance rate, loss to follow-up, patient preference(s) and adverse events. Baseline assessments were repeated at 12 weeks and 6 months. Secondary outcomes (i.e., ulcer recurrence, healing rate and healing time) were also documented at these intervals. Intervention and healthcare utilization costs were calculated. Results Recruitment rate was 65%, while 75% of the exercise group participants attended all scheduled exercise sessions. All participants completed their compression therapy. No serious adverse or exercise-related adverse events were reported. Median ulcer healing time was shorter in the exercise group (29 (7-108) vs 42 (6-116) weeks). Conclusions The feasibility and acceptability of both a home-based, exercise-based, lifestyle intervention in conjunction with compression therapy, and the study procedures are supported.

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Ulcus cruris venosum

Maksimović¹

2023

Galenika Med J

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The article presents the definition of venous ulcers as the terminal stage of chronic venous insufficiency. The medical, socioeconomic, and epidemiological significance of this disease is discussed. The theories of the origin of venous ulcerations are presented, as well as original etiopathogenic concepts. It has been found that there are two types of venous ulcers caused by surface and perforator insufficiency (which are less extensive and have satisfactory therapeutic results), and ulcers due to reflux or obstruction of the deep system (which are accompanied by more severe microcirculatory and tissue changes and are refractory to most known therapeutic agents). The use of individual therapeutic modalities is presented (local and general measures, compression bandaging, and medicamentous and surgical therapy). Data on the results and indications for surgical treatment are also presented (crossectomy, stripping of surface trees, ligation and other procedures on insufficient perforators, saphenopopliteal anastomosis, femoro-femoral crossover anastomosis, interposition of venous trees, and other interventions on deep veins). The immediate and remote results of treatment depend on the etiological assessment of the disease and precise indication criteria.

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The Role of Microcirculatory Dysfunction in the Pathophysiology and Treatment of Venous Leg Ulcers

Cited by 3 publications

References 6 publications

Chronic Venous Insufficiency With Emphasis on the Geriatric Population

Chronic Venous Insufficiency With Emphasis on the Geriatric Population

Testing the feasibility of a co-designed intervention, comprising self-managed, home-based, exercise training with embedded behavioural support and compression therapy for people with venous leg ulcers receiving treatment at home (FISCU-II)

Ulcus cruris venosum

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