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1.
Lancet Haematol ; 7(1): e40-e49, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31786086

RESUMO

BACKGROUND: Early thrombus removal might prevent post-thrombotic syndrome by preserving venous function and restoring flow. Previous trials comparing additional catheter-directed thrombolysis to standard treatment showed conflicting outcomes. We aimed to assess the benefit of additional ultrasound-accelerated catheter-directed thrombolysis for the prevention of post-thrombotic syndrome compared with standard therapy in patients with iliofemoral deep-vein thrombosis. METHODS: We did a multicentre, randomised, single-blind, allocation-concealed, parallel group, superiority trial in 15 hospitals in the Netherlands. Patients aged 18-85 years with a first-time acute iliofemoral deep-vein thrombosis and symptoms for no more than 14 days were randomly assigned (1:1) to either standard treatment with additional ultrasound-accelerated catheter-directed thrombolysis or standard treatment alone. Randomisation was done with a web-based automatic programme and a random varying block size (2-12), stratified by age and centre. Standard treatment included anticoagulant therapy, compression therapy (knee-high elastic compression stockings; 30-40 mmHg), and early ambulation. Additional ultrasound-accelerated catheter-directed thrombolysis was done with urokinase with a starting bolus of 250 000 international units (IU) in 10 mL NaCl followed by a continuous dose of 100 000 IU/h for a maximum of 96 h through the Ekos Endowave-system. Adjunctive percutaneous transluminal angioplasty, thrombosuction, or stenting was performed at the discretion of the physician who performed the intervention. The primary outcome was the proportion of patients with post-thrombotic syndrome at 12 months diagnosed according to the original Villalta criteria-a Villalta-score of at least 5 on two consecutive occasions at least 3 months apart or the occurrence of venous ulceration-and was assessed in a modified intention-to-treat population of all randomly assigned patients who passed screening and started treatment. The safety analysis was assessed in the same modified intention-to-treat population. This study is complete and is registered at ClinicalTrials.gov, NCT00970619. FINDINGS: Between May 28, 2010, and Sept 18, 2017, 184 patients were randomly assigned to either additional ultrasound-accelerated catheter-directed thrombolysis (n=91) or standard treatment alone (n=93). Exclusion because of screening failure or early withdrawal of informed consent resulted in 77 patients in the intervention group and 75 in the standard treatment group starting allocated treatment. Median follow-up was 12·0 months (IQR 6·0-12·0). 12-month post-thrombotic syndrome occurred in 22 (29%) patients allocated to additional treatment versus 26 (35%) patients receiving standard treatment alone (odds ratio 0·75 [95% CI 0·38 to 1·50]; p=0·42). Major bleeding occurred in four (5%) patients in the intervention group, with associated neuropraxia or the peroneal nerve in one patient, and no events in the standard treatment group. No serious adverse events occurred. None of the four deaths (one [1%] in the intervention group vs three [4%] in the standard treatment group) were treatment related. INTERPRETATION: This study showed that additional ultrasound-accelerated catheter-directed thrombolysis does not change the risk of post-thrombotic syndrome 1 year after acute iliofemoral deep-vein thrombosis compared with standard therapy alone. Although this trial is inconclusive, the outcome suggests the possibility of a moderate beneficial effect with additional ultrasound-accelerated catheter-directed thrombolysis. Further research is therefore warranted to better understand this outcome in the context of previous trials, preferably by combining the available evidence in an individual patient data meta-analysis. FUNDING: The Netherlands Organisation for Health Research and Development (ZonMw), Maastricht University Medical Centre, BTG-Interventional Medicine.


Assuntos
Anticoagulantes/administração & dosagem , Cateterismo Periférico , Síndrome Pós-Trombótica/prevenção & controle , Terapia Trombolítica/métodos , Trombose Venosa/tratamento farmacológico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Método Simples-Cego , Meias de Compressão , Adulto Jovem
2.
Int J Sports Med ; 41(1): 3-11, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31791089

RESUMO

This study evaluated the morphological changes of the lower limb and associated hemodynamic responses to different lower-body compression pressures (COMPs) in physically active, healthy individuals at rest. Each of the 32 participants underwent three trials with three different degrees of lower-body compression applied: "Low" (2.2±1.4 mmHg), "Medium" (12.9±3.9 mmHg), and "High" (28.8±8.3 mmHg). In each COMP, a cross-sectional area of leg muscles (CSAmuscle), subcutaneous fat (CSAfat), superficial vessels (SupV), deep arteries (DA), and deep veins (DV) at the calf, knee, and thigh levels were measured using magnetic resonance imaging (MRI). Additionally, blood pressure (BP), heart rate (HR), cardiac output (CO), stroke volume (SV), and systemic vascular resistance (SVR) were measured using Doppler ultrasound (USCOM®). With High COMP, calf CSAmuscle and SupV were smaller (p<0.01), whereas DA and DV were larger (p<0.05). Calf CSAfat, however, was similar among all COMPs. There were no major changes in CSAmuscle and CSAfat at knee and thigh levels. CO (3.2±0.9 L/min) and SV (51.9±16.4 mL) were higher (p<0.05) only with High COMP, but other hemodynamic variables showed no significant changes across different COMPs. The High COMP at the lower limb induces leg morphological changes and increases associated hemodynamic responses of physically active healthy individuals at rest.


Assuntos
Hemodinâmica/fisiologia , Extremidade Inferior/fisiologia , Meias de Compressão , Artérias/diagnóstico por imagem , Artérias/fisiologia , Pressão Sanguínea/fisiologia , Estudos Cross-Over , Feminino , Frequência Cardíaca/fisiologia , Humanos , Extremidade Inferior/irrigação sanguínea , Extremidade Inferior/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Músculo Esquelético/irrigação sanguínea , Músculo Esquelético/diagnóstico por imagem , Músculo Esquelético/fisiologia , Volume Sistólico/fisiologia , Gordura Subcutânea/irrigação sanguínea , Gordura Subcutânea/diagnóstico por imagem , Gordura Subcutânea/fisiologia , Ultrassonografia Doppler , Resistência Vascular/fisiologia , Veias/diagnóstico por imagem , Veias/fisiologia , Adulto Jovem
3.
Hautarzt ; 71(1): 24-31, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-31845297

RESUMO

For the treatment of phlebological and lymphological diseases as well as constitutional edema diseases, a discussion of innovative concepts of medical compression therapy is essential. It is recommended that medical compression stockings should always be prescribed based on symptoms and with the lowest effective interface pressure to optimize the tolerability of compression therapy. Likewise, medical compression stockings with an integrated care formula, but also the application of additional skincare can improve the quality of life and compliance in patients with chronic venous insufficiency. Optimization of ulcer therapy can be achieved by using two-component compression stocking systems. These consist of an understocking and a firm outer compression stocking, which improve the venous and capillary hemodynamics with good wearing comfort and lead to the healing of venous ulcerations. Multicomponent compression bandages and short stretch bandages are proven in the decongestion phase of edema. Multicomponent bandages ensure a sustained interface pressure for at least 5 days and are ideal for outpatient treatment with less frequent dressing changes. For compression therapy in patients with arterial-venous leg ulcers (ABI [ankle brachial index] >0.5), specially developed "lite" versions of the multicomponent dressings can be used.


Assuntos
Meias de Compressão , Úlcera Varicosa , Insuficiência Venosa , Bandagens Compressivas , Humanos , Qualidade de Vida , Úlcera Varicosa/terapia , Insuficiência Venosa/terapia
4.
Angiol Sosud Khir ; 25(4): 102-107, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31855206

RESUMO

AIM: The purpose of the study was to assess efficacy and safety of heparin sodium gel 1000 IU/g and Detragel® in decreasing the incidence and treatment of the most common local adverse reactions in patients after endured sclerotherapy of reticular veins and telangiectasias. PATIENTS AND METHODS: Our open prospective observational study included a total of sixty 18-to-35-year-old female patients who after undergoing standardized sclerotherapy of reticular veins and telangiectasias on symmetrical portions of lower limbs were given a tube of heparin sodium gel 1000 IU/g or Detragel® to be applied onto the skin of one (left) lower limb in the projection of the sclerotherapy-exposed vessels 2-3 times daily for 10 days followed by putting on a compression class 2 (RAL standard) stocking. The women were allowed to use only the paired stocking on the contralateral extremity. Efficacy and safety of heparin sodium gel 1000 IU/g and Detragel® were evaluated based on the incidence of typical adverse reactions (ecchymoses, phlebitides, hyperpigmentation and neovasculogenesis), as well as on the patient's subjective perceptions. RESULTS: The use of heparin sodium gel 1000 IU/g and Detragel® in addition to compression after sclerotherapy of reticular veins and telangiectasias significantly and comparably decreased the incidence and accelerated the resolution of ecchymoses and phlebitides associated with phlebosclerosing treatment. The Detragel® group patients were found to develop hyperpigmentation or neovasculogenesis significantly less often as compared with the heparin sodium gel 1000 IU/g group women. What is more, using Detragel® was not accompanied by hyperkeratosis, pruritus or formation of a sticky film, the events, however, observed while applying heparin sodium gel 1000 IU/g. CONCLUSION: The use of Detragel® or heparin sodium gel 1000 IU/g for 10 days additionally to compression significantly decreased the incidence of typical undesirable reactions associated with sclerotherapy of reticular veins and telangiectasias. The Detragel® group women turned out to have lower incidence of hyperpigmentation and neovasculogenesis. Besides, Detragel® demonstrated better organoleptic properties.


Assuntos
Anticoagulantes/administração & dosagem , Heparina/administração & dosagem , Soluções Esclerosantes/efeitos adversos , Escleroterapia/efeitos adversos , Telangiectasia/terapia , Varizes/terapia , Administração Tópica , Feminino , Géis/administração & dosagem , Humanos , Hiperpigmentação/etiologia , Hiperpigmentação/prevenção & controle , Incidência , Neovascularização Patológica/etiologia , Neovascularização Patológica/prevenção & controle , Estudos Prospectivos , Meias de Compressão
5.
Angiol Sosud Khir ; 25(4): 108-115, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31855207

RESUMO

AIM: The purpose of the study was to compare the results of using compression knitwear and elastic bandaging in the postoperative period after endovasal laser coagulation in patients with varicose veins. PATIENTS AND METHODS: A total of forty 20-to-55-year-old women with a body mass index of ≤ 35 kg/m2 and CEAP class C2-C3 lower limb varicose veins were randomized into two numerically equal groups. The Study Group included those receiving postoperative compression on the operated leg with the help an elastic stocking, whereas in the Comparison Group compression was achieved by laying an elastic bandage. Both group women underwent laser coagulation of the great saphenous vein and removal of separate veins with the help of Mueller hooks. Efficacy of compression therapy was comparatively assessed based on the results of interviewing the patients prior to intervention and 1 month thereafter, as well as by the level of pain syndrome according to the visual analogue scale at 24 and 48 postoperative hours, by the time spent by the personnel for bandaging of the limb or putting on the compression stocking intraoperatively and at the first dressing, by the degree of lower limb oedema and dynamics of regression thereof, by the area of postoperative haematoma and its dynamics after 2, 7 days and at 1 month. Besides, we evaluated the findings of ultrasonographic angioscanning of lower limb veins at one month postoperatively. RESULTS: The obtained findings demonstrated that efficacy of using a medical compression stocking after the procedure of endovasal laser coagulation in women with varicose veins was comparable to that of elastic bandaging. By the incidence rate and area of extension of postoperative haematomas, degree of pain syndrome, patient-oriented assessment using the Chronic Venous Insufficiency Quality of Life Questionnaire (CIVIQ), condition of veins according to the findings of ultrasonographic angioscanning no significant differences were revealed between the two methods of elastic compression of the leg. However, using a medical stocking appeared to promote a statistically significant 1.4-1.6-fold reduction in the time spent for formation of elastic compression of the lower limb, as well as a decrease in the incidence rate and degree of local oedema of the lower limb in the postoperative period.


Assuntos
Bandagens Compressivas , Fotocoagulação a Laser/métodos , Varizes/terapia , Procedimentos Endovasculares , Feminino , Humanos , Qualidade de Vida , Meias de Compressão , Resultado do Tratamento , Varizes/complicações , Varizes/cirurgia , Insuficiência Venosa/etiologia , Insuficiência Venosa/cirurgia , Insuficiência Venosa/terapia
6.
Cochrane Database Syst Rev ; 9: CD004177, 2019 09 18.
Artigo em Inglês | MEDLINE | ID: mdl-31531971

RESUMO

BACKGROUND: Post-thrombotic syndrome (PTS) is a long-term complication of deep vein thrombosis (DVT) characterised by chronic complaints such as oedema and skin changes including; venous ectasia, varicose veins, redness, eczema, hyperpigmentation, and in severe cases fibrosis of the subcutaneous adipose in the affected limb. These chronic complaints are the effects of venous outflow restriction that can cause symptoms such as heaviness, itching, pain, cramps, and paraesthesia. Twenty to fifty percent of people with DVT develop post-thrombotic complications. Several non-pharmaceutical measures are used for prevention of PTS during the acute phase of DVT. These include elevation of the legs and compression therapy. There have been limited studies regarding the effectiveness of compression therapy for prevention or treatment of PTS. As a result, clinicians and guidelines differ in their assessment of compression therapy during treatment of DVT and in the treatment of PTS. This is an update of a review first published in 2003. OBJECTIVES: To assess the effectiveness of compression therapy for treatment of post-thrombotic syndrome, including elastic compression stockings and mechanical devices compared with no intervention, placebo and with each other. SEARCH METHODS: For this update, the Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase and CINAHL databases and World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registries on 2 July 2018. SELECTION CRITERIA: We included trials that evaluated compression therapy for the treatment of PTS. The primary outcomes were severity of PTS and adverse effects. There were no restrictions on date or language. Two review authors (SA, DNK) independently assessed whether potentially relevant studies met the inclusion criteria. DATA COLLECTION AND ANALYSIS: One review author extracted and summarised data and one review author (DNK) verified them. We resolved disagreements by discussion. We assessed methodological study quality with the Cochrane 'Risk of bias' tool. We used GRADE to assess the overall certainty of the evidence supporting the outcomes assessed in this review. MAIN RESULTS: We identified four trials, with 116 participants, investigating the effectiveness of compression therapy for treatment of PTS. The methodology used by each trial was too heterogeneous to perform a meta-analysis, so we reported our findings narratively.Two trials studied the effect of graduated elastic compression stockings (GECS) on improvement of PTS symptoms. One study reported beneficial haemodynamic effects, while the other found no benefits on PTS severity compared to placebo (very low-certainty evidence). There was very limited evidence available for adverse effects and quality of life (QoL). The two studies did not report on compliance rates during the study period.Two trials studied the effects of intermittent mechanical compression devices. Both reported improvement in PTS severity (low-certainty evidence). Improvement of the severity of PTS was defined by treatment 'success' or 'failure'. Only one study comparing compression devices evaluated adverse effects and QoL. Although 9% of the participants experienced adverse effects such as leg swelling, irritation, superficial bleeding, and skin itching (moderate-certainty evidence), QoL was improved (moderate-certainty evidence). Studies did not assess compliance using intermittent mechanical compression devices.None of the studies evaluated patient satisfaction. AUTHORS' CONCLUSIONS: There is very low-certainty evidence regarding the use of GECS for treatment of PTS as assessed by two small studies of short duration. One study reported beneficial haemodynamic effects, while one found no benefits on PTS severity compared to control/placebo stockings. There is very limited evidence for adverse effects, patient satisfaction, QoL, and compliance rates. There is low-certainty evidence favouring use of intermittent pneumatic compression devices compared to a control device for the treatment of severity owing to different measurements used by the studies reporting on this outcome and small studies of short duration. There is moderate-certainty evidence of improved QoL but possible increased adverse effects related to compression device use owing to small studies of short duration. High-certainty evidence to support the use of compression therapy in prevention of PTS is lacking and any conclusions drawn from current evidence should be interpreted with care. Further research is needed to assess whether compression can result in long-term reduction and relief of the symptoms caused by PTS, or prevent deterioration and leg ulceration.


Assuntos
Síndrome Pós-Trombótica/terapia , Meias de Compressão , Humanos , Síndrome Pós-Trombótica/etiologia , Síndrome Pós-Trombótica/prevenção & controle , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Trombose Venosa/complicações
7.
Hum Mov Sci ; 67: 102519, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31522078

RESUMO

Athletes use compression garments (CGs) to improve sport performance, accelerate rehabilitation from knee injuries or to enhance joint position sense (JPS). The position of CGs around the knee may affect knee JPS but the data is inconsistent. The purpose of the present study was to determine the effects of CG position on healthy adults' knee joint position sense acuity. In a counterbalanced, single-blinded study, 16 healthy young adults (8 female, age: 25.5 y) performed an active knee joint position-matching task with and without (CON) a below-knee (BK), above-knee (AK), or whole-knee (WK) CG in a randomized order on the dominant (CompDom) or the non-dominant leg (CompNon-Dom). We also determined the magnitude of tissue compression by measuring anatomical thigh and calf cross sectional area (CSA) in standing using magnetic resonance imaging (MRI). Subjects had less absolute repositioning error (magnitude of error) in BK compared with CON condition. On the other hand, the analysis of the direction of error (constant error) revealed that in each condition subjects tended to underestimate the target position (AK, BK and CON: 75%; WK: 94%). In WK condition there was a significantly larger negative error (-2.7 ±â€¯3.4) as compared with CON (-1.6 ±â€¯3.7) condition. There also was less variable error, in WK compared to BK and CON conditions, indicating less variability in their position sense using a WK CG, regardless of the underestimation. CG reduced thigh CSA by 4.5 cm2 or 3% and calf CSA by Δ1.3 cm2 or 1%. The position of CG relative to the knee modifies knee JPS. The findings helps us better understand how the application of a WK CG may support athletic activities.


Assuntos
Articulação do Joelho/fisiologia , Propriocepção/fisiologia , Meias de Compressão , Adulto , Feminino , Voluntários Saudáveis , Humanos , Traumatismos do Joelho/fisiopatologia , Imagem por Ressonância Magnética , Masculino , Pressão , Método Simples-Cego , Adulto Jovem
8.
Clin Interv Aging ; 14: 1153-1157, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31417245

RESUMO

Background: The thromboprophylactic efficacy of graduated compression stockings (GCS) has not yet been demonstrated in acutely ill medical patients, and guidelines vary considerably. Older acutely ill medical patients appear to constitute a distinctive population presenting high risks of both thrombosis and bleeding. Objective: To evaluate the practices and beliefs of a panel of French geriatricians regarding GCS management in acutely ill medical patients aged over 75 years. Methods: A survey was designed to study French geriatric practice concerning GCS use for thromboprophylaxis. Results: A total of 111 geriatricians answered the questionnaire. Among the responders, 46% declared frequent or very frequent prescription of GCS for preventing venous thromboembolism (VTE) in acutely ill, hospitalized medical patients, 54% declaring that they frequently re-evaluated GCS prescription during the patient's hospitalization. The main reason reported for discontinuing GCS use was patient request. Regarding complications of GCS, 87% of responders declared having already noted adverse effects with the use of GCS, although 80% estimated the risk of complications to be low or very low. In the context considered, the efficacy of wearing GCS was believed to be high or very high for 73% of responders. GCS prescription was judged to be in accordance with evidence-based medicine for 69%. Conclusion: There is a gap between the frequent use of GCS to prevent VTE in older patients presenting an acute medical illness and the availability of data concerning their efficacy, safety, and management by nurses. Prospective trials including clinical and cost effectiveness are needed.


Assuntos
Geriatras/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Meias de Compressão/estatística & dados numéricos , Tromboembolia Venosa/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Medicina Baseada em Evidências , Feminino , França , Humanos , Masculino , Fatores de Risco , Inquéritos e Questionários
9.
10.
Dtsch Med Wochenschr ; 144(16): e94-e101, 2019 08.
Artigo em Alemão | MEDLINE | ID: mdl-31416099

RESUMO

INTRODUCTION: Patients with leg ulcers often have severe edema of the lower extremities, which should be treated as part of a successful wound treatment. Today in Germany the necessary compression therapies are often performed with very error-prone and time-consuming short-stretch bandages only. Multicomponent systems, adaptive compression bandages and leg ulcer stocking systems are newer, much less error-prone treatment options. In addition to the often lacking knowledge, the fears of high costs are also mentioned as reasons for the lack of prescription of these systems. It was therefore our aim to investigate the costs of different treatment options, differentiated in the outpatient and inpatient sector. METHODS: For the economic calculations, both material and personnel costs were taken into account for different scenarios. RESULTS: Both material and personnel costs were included in the calculation. We were able to demonstrate that the cost for a continuous compression therapy for inpatients accrues between 5.29 Euros to 18.50 Euros per day. For the outpatient setting costs of 2.29 Euros to 34.29 Euros per day were calculated. The different constellations of compression therapy can make sense thus not only for medically but also for economically aspects. CONCLUSION: As a consequence of this data, both the different systems and the economic factors of compression therapy in patients with leg ulcers should be known to the therapists. These treatment options should then be prescribed and performed according to individual factors, taking into account the needs and abilities of the patients.


Assuntos
Bandagens Compressivas , Úlcera da Perna , Meias de Compressão , Bandagens Compressivas/economia , Bandagens Compressivas/estatística & dados numéricos , Alemanha , Custos de Cuidados de Saúde , Humanos , Úlcera da Perna/economia , Úlcera da Perna/epidemiologia , Úlcera da Perna/terapia , Meias de Compressão/economia , Meias de Compressão/estatística & dados numéricos
11.
Vasa ; 48(6): 502-508, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31364497

RESUMO

Background: Because of side effects like skin dryness and consecutive symptoms like itching the therapy of chronic venous insufficiency (CVI) with medical compression stockings (MCS) can lead to a diminished wear comfort and restricted compliance. Compression stockings with integrated skin care may have a positive influence on the skin hydration and moreover a positive effect on patients compliance. Patients and methods: In this monocentric, randomized prospective, controlled trial a below knee conventional MCS was compared to a medical compression stocking with integrated skin care (MCS-SC), interface pressure range 23-32 mmHg. Participants: 50 patients with CVI. Primary outcome: skin hydration. Secondary outcomes: transepidermal water loss, skin roughness, leg volume, interface pressure and questionnaires about quality of life and wear comfort. Results: In patients wearing MCS the skin moisture decreased (p = 0.021) and the skin roughness increased significantly (p = 0.001), whereas in patients wearing the MCS-SC skin moisture and skin roughness changed only slightly (n.s.). These protective effects of MCS-SC compared to MCS were most common in patients with CVI at stage 3 (p = 0.046), in male patients (p = 0.013) and patients with initial dry skin (p = 0.034). Both MCS reduced lower leg volume, MCS by 80 ml (p < 0.001) and MCS-SC by 60 ml (p < 0.001), both MCS improved quality of life: leg complaints (p = 0.0003); functional status (p = 0.010), well-being and life satisfaction (p = 0.030). Wear comfort: In terms of tightness, constriction in bond area and strenuous donning the MCS-SC was assessed significantly more comfortable than MCS (p < 0.001). Conclusions: MCS-SC revealed to be superior to MCS with regard to skin moisture, particularly in patients with low skin humidity, in male patients and in patients with C3, varicose veins accompanied by edema.


Assuntos
Meias de Compressão , Insuficiência Venosa , Doença Crônica , Humanos , Masculino , Estudos Prospectivos , Qualidade de Vida
12.
Minerva Cardioangiol ; 67(4): 280-287, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31347820

RESUMO

BACKGROUND: The aim of this prospective supplement summer registry study was to evaluate the efficacy of Pycnogenol® in controlling symptoms of chronic venous insufficiency (CVI) and microcirculatory parameters: venous hypertension and microangiopathy. Pycnogenol® (Horphag Research) is the standardized extract of the bark of Pinus Pinaster. METHODS: During the summer period between June and August 142 patients were split into three groups: 1) Pycnogenol® 150 mg/day; 2) compression stockings; 3) and compression + Pycnogenol®. RESULTS: Venous pressure (ambulatory venous pressure, AVP) and refilling time (RT), microcirculatory and clinical measurements were comparable at inclusion. At 8 weeks variations in skin flux (RF), rate of ankle swelling (RAS), skin PO2-PCO2, Analogue Symptomatic Score (ASLS), Venous Disability and severity Scores and local oxidative stress (OS) indicated a statistically significant improvement by Pycnogenol® both as a single supplement and in association with compression in comparison with baseline. Pycnogenol® significantly improved the microcirculation in comparison with compression (P<0.05). The combined effects of Pycnogenol+compression produced the best results in most measurements. The summer study penalized compression - in a very hot summer - with many drops out. No side effects due to supplementation were observed; tolerability was optimal. The tolerability to stocking was less than optimal (70% of compression not correctly used). Pycnogenol® alone was more effective than compression alone. The increase (P<0.05) in skin O2 and the decrease in PCO2 were associated with the decrease in skin flux. The variations in capillary filtration (RAS) were the most important microcirculation changes. RAS is directly associated with swelling, the hallmark of CVI. Pycnogenol® in both Pycnogenol groups significantly improved RAS in comparison with compression only (P<0.05). The decrease in OS in both Pycnogenol® groups was significant in comparison with compression only (P<0.05). A lower OS is an important micro-metabolic indication of a better capillary bed with better nutritional, perfusional exchanges. The clinical measurements followed the patterns of the microcirculation with the supplement groups performing statistically better (P<0.002) than the compression-only. CONCLUSIONS: This "summer registry" study confirms the clinical and microcirculatory efficacy of Pycnogenol in CVI and venous microangiopathy. The study indicates the significant clinical role of Pycnogenol® (both as a single treatment and in association with compression) in the management, treatment and control of this common clinical problem.


Assuntos
Flavonoides/administração & dosagem , Microcirculação/efeitos dos fármacos , Extratos Vegetais/administração & dosagem , Meias de Compressão , Insuficiência Venosa/tratamento farmacológico , Adulto , Doença Crônica , Terapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estresse Oxidativo , Estudos Prospectivos , Sistema de Registros , Índice de Gravidade de Doença , Insuficiência Venosa/fisiopatologia
13.
Medicine (Baltimore) ; 98(29): e16552, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31335737

RESUMO

We report the outcomes of mechanical prophylaxis and chemoprophylaxis in patients who underwent elective surgery for idiopathic adolescent scoliosis (AIS).We retrospectively studied the patients who underwent posterior spinal instrumentation for AIS. The patients were divided into three groups: Group A low-molecular-weight heparin (LMWH) started at 8 hours after surgery; Group B LMWH started at 24 hr after surgery; Group C did not receive chemoprophylaxis. The data about wound oozing, need for transfusion, preoperative and postoperative hemoglobin level, length of stay in hospital, interval from the surgery to removal of closed suction drainage tube, postoperative blood loss from closed suction drain, deep venous thrombosis (DVT), and pulmonary embolism (PE) were investigated.The mean age and Lenke classification for all the groups were similar. No DVT or PE was detected in any group. The mean blood loss from the drain was higher in Group A (400 mL) and Group B (450 mL) when compared to Group C (150 mL) (P = .001). There were more wound oozing in Groups A (5) and B (6) than in Group C (3) (P = .585). Three patients in Group B, 3 patients in Group A, and no patient in Group C had superficial infections. However, there was no statistical difference between the groups (P = .182). Postoperative hospital stay was significantly longer in Groups A (6 days) and B (6 days) then in Group C (5 days) (P = .001).Our current study claims that chemoprophylaxis is not necessary for the patients without risk factors after AIS surgery. Early mobilization and mechanoprophylaxis represents adequate prophylaxis in addition to pain management and well hydration in patients' routine treatment. The complications of chemoprophylaxis are not correlated to the initiation time of prophylaxis.


Assuntos
Anticoagulantes/uso terapêutico , Heparina de Baixo Peso Molecular/uso terapêutico , Embolia Pulmonar/prevenção & controle , Escoliose/cirurgia , Trombose Venosa/prevenção & controle , Adolescente , Anticoagulantes/efeitos adversos , Transfusão de Sangue , Esquema de Medicação , Deambulação Precoce , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Feminino , Hemoglobinas/metabolismo , Heparina de Baixo Peso Molecular/efeitos adversos , Humanos , Tempo de Internação , Masculino , Complicações Pós-Operatórias/prevenção & controle , Hemorragia Pós-Operatória/terapia , Estudos Retrospectivos , Fatores de Risco , Meias de Compressão , Sucção , Infecção da Ferida Cirúrgica , Procedimentos Desnecessários
15.
Transplant Proc ; 51(6): 1838-1844, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31256870

RESUMO

OBJECTIVE: The aim of this study was to evaluate the effects of using thromboembolic deterrent (TED) stockings and intermittent pneumatic compression (IPC) vs a muscle pump activator (MPA) device on limb edema and patient satisfaction after transplant. METHODS: In this single-center randomized controlled trial, 118 patients were randomly assigned to wear TED + IPC (n = 64) or the MPA device (n = 54) from postoperative days 1 to 6. We measured patients' weight and lower leg and thigh circumferences daily. Ultrasonography of the allograft and lower limbs was carried out on postoperative days 1 and 5 to assess resistive index in the transplanted kidney and flow in the femoral vein. We monitored urine output and serum creatinine level. RESULTS: We observed a significant increase in calf and thigh circumference from baseline in the TED + IPC group but not in the MPA group (2.3 [SD, 1] cm vs 0.25 [SD, 0.8] cm, respectively, P < .002). Ultrasonography showed higher femoral vein velocities in the MPA group than the TED + IPC group (0.5 [SD, 0.2] cm, P < .001). The mean total urine output in 6 days was higher in the MPA group than the TED + IPC group (P = .05), which corresponded to large change in TED + IPC weight of 6.2 kg vs 2.1 kg in the MPA group (P = .04). Patients were more satisfied with the use of the MPA device than TED + IPC. No major complications were encountered in either group. CONCLUSIONS: This is the first study to show that the use of an MPA device in the immediate postoperative period following kidney transplant leads to decreased lower limb edema and increased total urine output. Patients were more satisfied with the use of the MPA device than TED + IPC.


Assuntos
Circulação Assistida/instrumentação , Edema/terapia , Terapia por Estimulação Elétrica/instrumentação , Transplante de Rim/efeitos adversos , Complicações Pós-Operatórias/terapia , Adulto , Idoso , Circulação Assistida/métodos , Velocidade do Fluxo Sanguíneo/fisiologia , Edema/etiologia , Edema/fisiopatologia , Terapia por Estimulação Elétrica/métodos , Feminino , Veia Femoral , Hemodinâmica/fisiologia , Humanos , Extremidade Inferior/irrigação sanguínea , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Período Pós-Operatório , Meias de Compressão , Resultado do Tratamento
16.
Vasa ; 48(5): 413-417, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31159678

RESUMO

Background: Theoretically progressive compression stockings, which produce a higher compression at the calf than at the ankle level, improve venous return flow without exacerbating peripheral arterial insufficiency (PAD). We aimed to evaluate the short-term tolerance of elastic progressive compression stockings on peripheral arterial vascularisation in patients with symptomatic PAD and associated mild venous insufficiency. Patients and methods: Monocentric, prospective, open pilot study of 18 patients (acceptability study, 6 x 6 plan) evaluating the short-term tolerance of progressive compression stockings (18 ± 2 mmHg at calf and 8 ± 2 mmHg at ankle level) in patients with PAD (ankle brachial index ABI > 0.60 < 0.75) and chronic venous insufficiency (C1s-C4 stages of the CEAP classification). Day 15 tolerance was evaluated by a composite primary criteria comprising: no decrease > 15 % of ABI on each side, no decrease > 15 % of toe brachial index (TBI) on each side and no decrease > 25 % of the number of active plantar flexions performed while standing. Results: The proportion of men was 77.8 %, mean age was 77.3 ± 7.5 years and no patient were diabetic. At inclusion, the mean low ABI was 0.60 ± 0.04 and the mean high ABI was 0.77 ± 0.18. The mean low TBI was 0.32 ± 0.09 and the mean high TBI 0.46 ± 0.15. The mean number of active standing plantar flexions was 33.0 ± 5.0. The majority of the patients were classified in CEAP C2s and C3 classes (class 2: 16.7 %, class C2s: 27.8 %, class C3: 44.4 %, class C4: 5.6 % and class C4s: 5.6 %). Poor tolerance occurred in no patient. By day 30, no patient had worsening of their arterial and venous symptoms. No adverse events occurred during the study. Conclusions: These results suggest a high tolerance of progressive elastic stockings (18 ± 2 mmHg at calf and 8 ± 2 mmHg at ankle level) in symptomatic PAD.


Assuntos
Doença Arterial Periférica , Insuficiência Venosa , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Projetos Piloto , Estudos Prospectivos , Meias de Compressão
17.
Hautarzt ; 70(9): 707-714, 2019 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-31165190

RESUMO

BACKGROUND: The pressure exerted by a compression device on a part of the body corresponds to the dosage of the compression therapy. Therefore, the pressure course under compression materials should be investigated in different clinical situations. MATERIAL AND METHODS: Pressure measurements were carried out under different compression materials in lying, standing and walking positions within the framework of training, self-experimentation and in patients with venous leg ulcers. RESULTS: The results showed that the pressure varied considerably depending on the material used, the firmness of application, the local configuration (body position) and the time interval between applications. A loss of pressure occurred under each compression therapy, especially under inelastic short-stretch material, mainly due to movement and edema reduction. This pressure loss is decisive for the timing of dressing changes and a reason for the good tolerance of high-pressure levels in mobile patients. CONCLUSION: Low pressures are particularly suitable for edema reduction. Hemodynamic effects require higher pressures (60-80 mmHg). For this purpose, inelastic materials are preferred which enable lower pressures when lying down (40-60 mmHg). As compression bandages are too loosely applied by many users, pressure indicators on bandages or adaptive bandages with templates are helpful to apply the material with the correct pressure. As a consequence of these findings it is postulated that, at least in studies comparing different compression media, pressure measurements should be carried out in the future, whereby the measuring point and body position should be documented.


Assuntos
Bandagens Compressivas , Edema/terapia , Meias de Compressão , Úlcera Varicosa/prevenção & controle , Insuficiência Venosa/terapia , Humanos , Perna (Membro)/fisiopatologia , Pressão , Posição Ortostática
18.
J Wound Care ; 28(Sup6a): 1-44, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31173547

RESUMO

The following supplement is a rare example of a paper that combines clinical experience and theoretical knowledge on textiles used in compression therapy. The authors' intention is to propose a decision support system for choosing specific compression devices, which can be adjusted to counteract the individual signs and symptoms in an optimally adopted way. The document concentrates on compression devices which can be self-applied by the patients-compression stockings and adjustable wraps. The acronym 'S.T.R.I.D.E.', incorporating both textile characteristics and clinical presentation, stands for: Shape, Texture, Refill, Issues, Dosage and Etiology. The intent of the mnemotechnical value is to highlight that successful compression includes more than dosage alone. In addition to dosage, etiology and patient presentation need to be incorporated, including a patient's physical ability to use compression effectively as part of the daily routine, thereby promoting adherence. The suggested algorithms provide a valuable guide to stride across the important, but still underestimated field of medical compression therapy and will help to put the prescription of a specific product on a more rational basis. Enjoy reading! Hugo Partsch Emeritus Professor Medical University of Vienna, Austria.


Assuntos
Bandagens Compressivas , Edema/terapia , Linfedema/terapia , Úlcera Varicosa/prevenção & controle , Técnicas de Apoio para a Decisão , Humanos , Cooperação do Paciente , Meias de Compressão , Úlcera Varicosa/terapia
19.
Vasa ; 48(6): 492-501, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31244386

RESUMO

Background: Vein symptoms (VS) entail diffuse leg discomfort and pain coinciding with a perception of weighty or swollen legs. Their traditional classification as a form of venous disease may be inaccurate as they occur in patients with no or any venous disorder. We hypothesized that VS would emerge from a primordially standing associated perturbation in the lower limbs which is not necessarily connected with a venous disorder. Patients and methods: Patients were sorted into groups according to the CEAP classification, VS only (C0s), primary varicose veins (C2p), varicose veins plus oedema (C2p and C3), and venous dermatopathy (C4). Patients completed questionnaires before and one week after they were exposed to a test of stationary standing. Results: Patients (N = 127) in the four groups differed by sex, age and body weight. The VS experienced in the preceding week scored the same in all groups at 3.1 on a numeric rating scale (range 0-10; SD 1.6). During standing, lower leg volume increased and symptoms emerged to the same extent across patient groups and were reduced similarly by compression (volume by 1.7 %, symptoms by 41.7 %). The emergence of symptoms was neither correlated with leg volume increase per se, nor with limiting this increase by compression. Symptoms recorded at baseline correlated with the symptoms provoked by the stress test with bare legs while the symptoms reported at follow-up, when stockings were worn regularly, correlated with the stress test with compression. Conclusions: VS, in terms of neuropsychology, reflect a homeostatic disturbance experienced in the presence and absence of venous disease. Thus, VS are not distinctive for the presence of venous disease insofar as they may reflect dynamic homeostatic feelings resulting from a standing-related disequilibrium in the legs' internal environment.


Assuntos
Varizes , Insuficiência Venosa , Edema , Emoções , Humanos , Perna (Membro) , Meias de Compressão , Veias
20.
Brasília; CONITEC; jun. 2019. graf, ilus, tab.
Não convencional em Português | BRISA/RedTESA | ID: biblio-1024738

RESUMO

CONTEXTO: O objetivo deste relatório é analisar as evidências científicas sobre a eficácia, efetividade e segurança das meias elásticas compressivas para a prevenção da recorrência da úlcera venosa (UV) em pacientes com IVC CEAP 5. As UV compreendem o tipo mais comum de ulceração da perna, representando cerca de 80% das úlceras nos membros inferiores. Atinge aproximadamente 1% da população global, podendo atingir até 2% dos indivíduos com mais de 80 anos de idade. A natureza refratária da UV é alta e cerca de 70% delas apresentam recidiva. Diante disso, o foco da gestão da UV passou a ser, além da sua cura, a sua prevenção. Essas meias compõem um método para aplicação de compressão física externa, sendo recomendada, dentre outras coisas, para a prevenção da recorrência de UV. TECNOLOGIA: Meias elásticas compressivas. PERGUNTA: O uso de meias elásticas compressivas é eficaz, efetivo e seguro no tratamento da IVC CEAP 5? EVIDÊNCIAS CIENTÍFICAS: Cinco estudos que avaliaram a eficácia, efetividade e segurança do uso de meias compressivas na prevenção de recorrência de UV foram incluídos, sendo uma revisão sistemática, dois ensaios clínicos randomizados e dois estudos observacionais de coorte. De uma maneira geral, os estudos apontam que o uso adequado da meia compressiva reduz a recorrência da UV. AVALIAÇÃO ECONÔMICA: Foi conduzida avaliação econômica do tipo árvore de decisão, na perspectiva do Sistema Único de Saúde (SUS), em um horizonte temporal de seis meses. Os dados de efetividade foram expressos em anos de vida ajustados pela qualidade (QALY - do inglês Quality-adjusted life year), mostrando que a estratégia com meias foi dominante, pois apresentou menor custo e maior efetividade quando comparada à estratégia sem meias. A razão de custo efetividade incremental foi de R$1.108,51 por QALY. As variáveis que mais alteram o resultado final do modelo são a probabilidade de o paciente evoluir para CEAP 6 usando meias, o custo do tratamento do paciente com CEAP 6 e a probabilidade de cicatrização do paciente CEAP 6. AVALIAÇÃO DE IMPACTO ORÇAMENTÁRIO: Realizou-se análise de impacto orçamentário em um horizonte temporal de cinco anos. Assumiu-se um market share inicial de 20% para as meias compressivas, com incrementos anuais no mesmo valor, chegando a 100% no quinto ano. Dois cenários foram estimados. O cenário 1 levou em consideração apenas os custos com a aquisição das meias elásticas, resultando em uma estimativa média de IO de R$79.586.919,18 no primeiro ano, aumentando para R$ 210.555.930,38 no segundo ano, podendo chegar a R$547.809.592,24 no quinto ano. O cenário 2, em que o custo anual de aquisição das meias e o custo médio do tratamento de uma recorrência de UV foram considerados, a estimativa chegaria a R$5.689.074.576,65 no primeiro ano, aumentando para R$6.689.345.168,94 no segundo ano, reduzindo a R$4.350.897.158,39 no quinto ano. CONSIDERAÇÕES FINAIS: De acordo com as evidências elencadas neste relatório, o uso de meias compressivas parece ser eficiente na prevenção da recorrência de UV em pacientes com IVC CEAP 5, desde que haja adesão ao tratamento e acompanhamento por profissionais de saúde. RECOMENDAÇÃO PRELIMINAR: A CONITEC, em sua 76ª reunião ordinária, no dia 04 de abril de 2019, recomendou a não incorporação no SUS das meias elásticas compressivas para insuficiência venosa crônica CEAP C5. Considerou-se que há incerteza quanto à adesão ao uso das meias elásticas pela população brasileira, dadas as características climáticas e geográficas do país. Além disso, considerando que a prevalência e a incidência utilizadas no IO foram provenientes de estudos internacionais, uma vez que há escassez de dados epidemiológicos no cenário brasileiro, a estimativa de IO pode não condizer com a real situação do Brasil e estar subestimada, pois o número de meias a ser utilizada no País poderia ser maior que a estimativa internacional de duas meias por ano. A matéria foi disponibilizada em consulta pública. CONSULTA PÚBLICA: Foram recebidas 17 contribuições, sendo 1 de cunho técnico científico e 16 de experiências e opiniões. A contribuição técnico-científica levantou alguns aspectos relacionados ao manejo da insuficiência venosa crônica, a população mais atingida e a necessidade de prevenção da recorrência. Das 16 contribuições de opiniões e experiências, 11 contrárias e 5 favoráveis. RECOMENDAÇÃO FINAL: Os membros da CONITEC presentes na 78ª reunião ordinária, no dia 06 de junho de 2019, deliberaram, por unanimidade, por recomendar a não incorporação no SUS de meias elásticas para IVC CEAP 5, pelos motivos já expostos no relatório. DECISÃO: Não incorporar as meias elásticas compressivas para pacientes com insuficiência venosa crônica classificação CEAP 5, no âmbito do Sistema Único de Saúde ­ SUS. Dada pela Portaria nº 36, publicada no Diário Oficial da União nº 140, seção 1, página 71, em 23 de julho de 2019.


Assuntos
Humanos , Insuficiência Venosa , Perna (Organismo) , Meias de Compressão , Avaliação da Tecnologia Biomédica , Sistema Único de Saúde , Brasil , Análise Custo-Benefício/economia
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