Characteristics, risk factors and treatment reality in livedoid vasculopathy - a multicentre analysis.

BACKGROUND: Livedoid vasculopathy (LV) is a rare cutaneous thrombotic disease. It is characterized by occlusion of dermal vessels resulting in livedo racemosa, ulceration and atrophie blanche. Clear guidelines for diagnosis and treatment are missing. OBJECTIVE: The purpose of this study was to better characterize epidemiology, clinical appearance and treatment reality of LV in a well-defined patient cohort. METHODS: The cohort was allocated within a prospective, multicentre, phase IIa trial that investigated the effect of rivaroxaban in LV. RESULTS: Analysis of 27 patients revealed that LV patients had an increased Body Mass Index (BMI; 11/27), hypertension (19/27) and increased levels of lipoprotein (a) (5/12) and homocysteine (10/12) in the blood. The female-to-male ratio was 2.1 : 1, and the median age was 53.0 years [interquartile range (IQR) 40.5-68]. Investigation of the clinical appearance found that 82% of patients had livedo racemosa, and the ankle region was most likely to be affected by ulceration (56-70%). The analysis of patient treatment history showed that heparin was most effective (12/17), while anti-inflammatory regimens were, although often used (17/24), not effective (0/17). CONCLUSION: We add clinical clues for a data supported diagnosis of LV, and we provide evidence that anticoagulants should be administered in monotherapy first line (EudraCT number 2012-000108-13-DE).

[Phlebological emergencies]. / Phlebologische Notfälle.

BACKGROUND: Deep and superficial vein thromboses as well as variceal hemorrhages are emergencies. The risk of short- and long-term morbidity and mortality in vein thromboses is increased. Variceal hemorrhage harbors the risk of massive blood loss. Prompt and adequate therapy of these diseases is therefore essential. OBJECTIVES: Our aim was to give an overview of these phlebological emergencies. MATERIALS AND METHODS: Based on the current guidelines and supplemented by a selective literature search in PubMed, we summarize the most important aspects for clinical practice. RESULTS: In deep vein thrombosis, therapeutic anticoagulation and compression therapy are indicated for a duration of at least 3-6 months. A shorter duration is associated with a considerably increased recurrence rate. Basic measures in superficial vein thrombosis comprise mobilization, cooling, and compression. In case of tenderness on palpation, non-steroidal anti-inflammatory drugs are recommended. Indication for anticoagulation and its dose depends on length of the thrombus and distance of the proximal part of the thrombus towards the deep veins. Variceal hemorrhage is a complication of advanced varicosis and can usually be handled with simple measures such as elevation of the extremity and compression. CONCLUSIONS: Prompt diagnosis and therapy is essential in superficial and deep vein thrombosis to prevent short-term complications such as pulmonary embolism and growth of the thrombus as well as long-term complications such as postthrombotic syndrome with secondary varicosis and chronic leg ulcer. After the occurrence of varicophlebitis or variceal hemorrhage, treatment of varicosis is indicated to prevent recurrences.

[Diagnostic workup and therapy of acute venous diseases]. / Diagnostik und Therapie akuter venöser Erkrankungen.

Acute venous diseases, especially deep leg and pelvic vein thrombosis, present an angiological emergency and can lead to acute life-threatening events such as pulmonary embolism. Long-term consequences may be postthrombotic syndromes. In addition to stroke and myocardial infarction, deep leg and pelvic vein thrombosis are one of the most common cardiovascular diseases. Early diagnosis and rapid initiation of therapy are important.