A study of social isolation in patients with varicose veins of the lower extremities: A scoping review.

OBJECTIVES: To undertake a scoping review of the literature on social alienation in patients with lower extremity varicose veins in order to serve as a reference for future studies in the field. METHODS: With a focus on the phenomenon of social alienation in patients with varicose veins of the lower extremities, a systematic search of Chinese and English databases was carried out using the scoping review methodology as a framework. The included literature was summarized and analyzed with a time frame from database construction to June 24, 2024. RESULTS: A total of 15 publications were included, demonstrating that social alienation is a frequent occurrence in people with varicose veins of the lower extremities but has not yet received much attention. In individuals with varicose veins of the lower limbs, demographic factors, illness issues, psychological problems, and social factors are the key influences on social alienation. CONCLUSION: Social alienation is a common phenomenon that is unevenly distributed in patients with varicose veins of the lower leg and is influenced by a number of different circumstances. In order to better meet the social needs of patients, healthcare professionals should pay attention to the issue of social alienation in patients with varicose veins of the lower extremity, identify and implement intervention strategies quickly, and actively explore a new model of treatment and care for social alienation.

A Systematic Review of the Safety and Efficacy of Inferior Vena Cava Stenting.

OBJECTIVE: Inferior vena cava (IVC) stenting may provide benefit to patients with symptomatic obstruction; however, there are no devices currently licensed for use in the IVC and systematic reviews on the topic are lacking. The aim of this study was to carry out a systematic review of the literature and meta-analysis to investigate the safety and efficacy of IVC stenting in all adult patient groups. DATA SOURCES: The Medline and Embase databases were searched for studies reporting outcomes for safety and effectiveness of IVC stenting for any indication in series of 10 or more patients. REVIEW METHODS: A systematic review of the literature was carried out according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS: Thirty-three studies were included describing 1 575 patients. Indications for stenting were malignant IVC syndrome (229 patients), thrombotic disease (807 patients), Budd-Chiari syndrome (501 patients), and IVC stenosis post liver transplantation (47 patients). The male:female ratio was 2:1 and the median age ranged from 30 to 61 years. The studies included were not suitable for formal meta-analysis as 30/33 were single centre retrospective studies with no control groups and there was considerable inconsistency in outcome reporting. There was significant risk of bias in 94% of studies. Median reported technical success was 100% (range 78 - 100%), primary patency was 75% (38 - 98%), and secondary patency was 91.5% (77 - 100%). Major complications were pulmonary embolism (three cases), stent migration (12 cases), and major bleeding (15 cases), and there were three deaths in the immediate post-operative period. Most studies reported improvement in clinical symptoms but formal reporting tools were not used consistently. CONCLUSION: The evidence base for IVC stenting consists of predominantly single centre, retrospective, observational studies that have a high risk of bias. Nonetheless the procedure appears safe with few major adverse events, and studies that reported clinical outcomes demonstrate improvement in symptoms and quality of life. Randomised controlled trials and prospective registry based studies with larger patient numbers and standardised outcome are required to improve the evidence base for this procedure.

Spontaneous Bone Marrow Edema: Perfusion Abnormalities and Treatment with Surgical Decompression.

Bone marrow edema (BME), also termed bone marrow lesions, is a syndrome characterized by bone pain and the appearance of high signal intensity on T2 fat-suppressed and short tau inversion recovery (STIR) MRI sequences. BME can be related to trauma or a variety of non-traumatic diseases, and current treatment modalities include non-steroidal anti-inflammatory drugs (NSAIDS), bisphosphonates, denosumab, extracorporeal shockwave therapy (ESWT), the vasoactive prostacyclin analogue iloprost, and surgical decompression. Spontaneous BME is a subset that has been observed with no apparent causative conditions. It is most likely caused by venous outflow obstruction and intraosseous hypertension. These are mechanistically related to impaired perfusion and ischemia in several models of BME and are related to bone remodeling. The association of perfusion abnormalities and bone pain provides the pathophysiological rationale for surgical decompression. We present a case of spontaneous BME and a second case of spontaneous migratory BME treated with surgical decompression and demonstrate resolution of pain and the high signal intensity on MRI. This report provides an integration of the clinical syndrome, MR imaging characteristics, circulatory pathophysiology, and treatment. It draws upon several studies to suggest that both the bone pain and the MRI characteristics are related to venous stasis, and when circulatory pathologies are relieved by decompression or fenestration, both the bone pain and the MRI signal abnormalities resolve.

Examining the effect of wound cleansing on the microbiome of venous stasis ulcers.

Common treatment for venous leg wounds includes topical wound dressings with compression. At each dressing change, wounds are debrided and washed; however, the effect of the washing procedure on the wound microbiome has not been studied. We hypothesized that wound washing may alter the wound microbiome. To characterize microbiome changes with respect to wound washing, swabs from 11 patients with chronic wounds were sampled before and after washing, and patient microbiomes were characterized using 16S rRNA sequencing and culturing. Microbiomes across patient samples prior to washing were typically polymicrobial but varied in the number and type of bacterial genera present. Proteus and Pseudomonas were the dominant genera in the study. We found that washing does not consistently change microbiome diversity but does cause consistent changes in microbiome composition. Specifically, washing caused a decrease in the relative abundance of the most highly represented genera in each patient cluster. The finding that venous leg ulcer wound washing, a standard of care therapy, can induce changes in the wound microbiome is novel and could be potentially informative for future guided therapy strategies.

[Purpura annularis telangiectodes : Case report and review of the literature]. / Purpura anularis teleangiectodes : Fallbericht und Literaturübersicht.

Pupura annularis telangiectodes (PAT) is a rare entity belonging to the spectrum of the pigmented purpuric dermatoses. PAT presents clinically as symmetric, annular erythema with teleangiectasia on the lower extremities and preferably affects young women. Histology usually reveals extravasated erythrocytes accompanied by a lymphocyte-dominated inflammatory infiltrate in the superficial dermis. Medication can often be identified as causative. In patients with idiopathic disease, topical corticoidsteroids are the treatment of choice. Compression therapy may be supportive.

Venous stasis retinopathy in a ten-year-old boy with ocular hypertension: a case report.

BACKGROUND: Central retinal vein occlusion is a variable disease pattern. Preliminary stages of a complete occlusion of the central vein, wich are subsumed under the term venous stasis retinopathy, may occur as transient blurred vision and with subtle alterations of the fundus. Course and prognosis are benign, visual acuity usually recovers. By now, venous stasis retinopathy in children due to Valsalva maneuver has not been described in literature yet. CASE PRESENTATION: We present an impressive case of venous stasis retinopathy in a 10-year-old boy with ocular hypertension and megalocornea due to increased intraocular pressure provoked by Valsalva maneuver. Main symptom was transient blurred vision in the left eye. The intraocular pressure was 28 mmHg, fundus exam revealed tortuous veins and a flame shaped hemorrhage at 7 o'clock. Total recovery under topical antiglaucomatous therapy could be observed after 1 month. CONCLUSIONS: Acute increase in intraocular pressure, provoked by Valsalva maneuver is a risk factor for venous stasis retinopathy. Further general and vascular risk factors should be ruled out by extensive examination. Children with ocular hypertension might be at higher risk for impending vein occlusion as shown in this case.

Relationship Between pH Shifts and Rate of Healing in Chronic Nonhealing Venous Stasis Lower-Extremity Wounds.

Venous stasis ulcers represent the majority of lower-extremity ulcers and place a considerable financial burden on the American health care system. Current standard of care therapies remain sub-optimal with 50% of venous stasis ulcers remaining unhealed after 4 months. Sixteen consecutive wounds were enrolled across 8 participants at a single center and underwent pH-driven therapy in addition to standard care as dictated by physicians. Following wound debridement, the pH of the wound bed was measured using pH strips. If acidic, normal saline was used to rinse the wound at every dressing change. If alkaline, nonsterile gauze was soaked in 0.25% acetic acid and applied to the wound for a minimum of 30 seconds. Participants were followed for 4 weeks with research staff observing compliance throughout. All 16 wounds had an alkaline pH at baseline, with an average pH of 8.25 ± 0.55 (range 7.5 to 9). Average area of the wound at the time of enrollment was (mean ± standard deviation) 285.48 ± 43.68 mm2, and average age of the wound was 37.5 ± 20.3 months (range 3 to 72). A simple linear regression model found a moderate relationship between pH and the rate of healing of chronic nonhealing venous stasis lower-extremity wounds (correlation coefficient  = 0.61). For every 1-unit change in pH, we can expect to see a change in wound size of 116.05 mm2. This is the first US-based, open-label, prospective study that examined the effect of pH on the rate of healing in chronic nonhealing venous stasis ulcer lowerextremity wounds.

Spectrum of Voriconazole-Induced Periostitis With Review of the Differential Diagnosis.

OBJECTIVE: Voriconazole is an antifungal medication used primarily for the treatment of Candida and Aspergillus infections. A fairly newly described side effect of long-term voriconazole use is periostitis. The purpose of this article is to describe the main differential consideration-hypertrophic osteoarthropathy-and other differential diagnoses, including venous stasis, thyroid acropachy, and hypervitaminosis A. CONCLUSION: With knowledge of imaging appearance, clinical manifestations, and outcomes, radiologists can make an accurate diagnosis of voriconazole-induced periostitis, and clinical teams can initiate appropriate management.

Active debridement of venous leg ulcers: a literature review to inform clinical practice.

Community nurses often care for patients with sloughy venous leg ulcers. Slough is viewed as a potential infection source and an impediment to healing, but it is unclear if active debridement of slough promotes healing. Using a clinical scenario as a contextual basis, this literature review sought research evidence to answer this clinical question. A strategy based on the '4S' approach was used to identify research evidence. The retrieved evidence included one systematic review, three clinical guidelines and six qualitative and quantitative studies. The analysis suggested that there is no robust evidence to support the routine practice of active debridement of venous leg ulcers to promote healing, and that debridement is associated with increased pain. Since autolytic debridement can be achieved through the application of graduated compression therapy, active debridement may offer no additional benefit.

Bilateral Phlegmasia Cerulea Dolens After Warfarin Reversal for Acute Rectal Bleeding: A Case Report.

BACKGROUND: Deep vein thrombosis (DVT) is a common disease that is diagnosed in approximately 1 in 1000 adults annually. Extensive DVT can lead to life- or limb-threatening diagnoses such as phlegmasia cerulea dolens (PCD), phlegmasia alba dolens, and venous gangrene. PCD, also known as massive iliofemoral venous thrombosis, is rare, and a severe complication of DVT. CASE REPORT: We report a case of a 94-year-old bedridden woman with past medical history of dementia, hypertension, pulmonary embolism, DVT, and atrial fibrillation. The patient was admitted to the hospital for bright red blood per rectum and an elevated international normalized ratio (INR) of 5.7. On admission, her dose of warfarin was suspended and she was given 4 units of fresh frozen plasma as well as 10 mg of i.v. vitamin K. She was discharged home with an INR normalized to 1.3 and cessation of her rectal bleeding. At discharge, she was not restarted on warfarin, nor was any bridging therapy used. The patient returned to the Emergency Department a week later for worsening pain and bluish discoloration of her bilateral lower extremities. An ultrasound (US) examination showed that she had developed bilateral PCD, after INR reversal. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency physicians commonly care for patients who present with acute DVT or treat patients on anticoagulant therapy who require cessation of medications or administration of prothrombotic agents to reverse bleeding. Cases of extensive clot burden leading to PCD have been reported in the literature, however, reports of bilateral PCD secondary to cessation of warfarin have been scarce. PCD should be considered carefully as one of the complications in warfarin reversal, as it requires immediate attention and surgical intervention to prevent limb loss.

Contribution of Circulatory Disturbances in Subchondral Bone to the Pathophysiology of Osteoarthritis.

PURPOSE OF REVIEW: This review describes the contributions of abnormal bone circulation to the pathophysiology of osteoarthritis. Combining dynamic imaging with MRI and PET with previous observations reveals that venous stasis and a venous outlet syndrome is most likely the key circulatory pathology associated with the initiation or progression of osteoarthritis. RECENT FINDINGS: MRI and PET have revealed that venous outflow obstruction results in physicochemical changes in subchondral bone to which osteoblasts are responsive. The osteoblasts express an altered pattern of cytokines, many of which can serve as structural or signaling molecules contributing to both bone remodeling and cartilage degeneration. The patterns of circulatory changes are associated with alterations in the physicochemical environment of subchondral bone, including hypoxia. Osteoblast cytokines can transit the subchondral bone plate and calcified cartilage and communicate with chondrocytes.

Venous Stasis and Cerebrovascular Complications in Cerebral Venous Sinus Thrombosis.

BACKGROUND/AIMS: The factors related to cerebrovascular complications in cerebral venous sinus thrombosis (CVST) are controversial. We focused on venous stasis and investigated its relationship with cerebrovascular complications in CVST. METHODS: CVST patients between June 2013 and October 2016 were enrolled. Relationships between cerebrovascular complications, defined as cerebral venous infarction, intracerebral hemorrhage, or subarachnoid hemorrhage, and cerebrum venous stasis and other clinical information were retrospectively analyzed. Venous stasis was evaluated by the prominence of the veins on susceptibility-weighted imaging (SWI). The cerebrum was divided into 10 regions according to the venous drainage territories, and venous stasis was quantified by adding one point for venous prominence on SWI for each region (CVST SWI score). RESULTS: All 5 cases in the noncomplicated group had a CVST SWI score of 0. The 3 patients with CVST SWI scores higher than 0 had cerebrovascular complications. The CVST SWI scores were higher in the complicated group than in the noncomplicated group (3.0 vs. 0, p = 0.010). Seizures were seen in all patients with complications and in none of the patients without complications (3 vs. 0, p = 0.018). CONCLUSION: Venous stasis evaluated by SWI can help predict cerebrovascular complications in CVST. A seizure is an important initial symptom that suggests cerebrovascular complications in CVST.

Venous status ulcers due to congenital agenesis of the inferior vena cava in a 16-year-old male.

We report a case of agenesis of the infrarenal inferior vena cava in a 16-year-old male presenting with venous stasis dermatitis and ulceration in the gaiter region bilaterally. Duplex imaging was performed revealing absence of infrarenal inferior vena cava and iliofemoral venous system. Magnetic resonance venography then confirmed the above findings along with revealing extensive lumbar and pelvic collateralization. This patient's condition has been successfully managed conservatively with compression therapy and wound care. This case is a rare example of a congenital malformation of the inferior vena cava and represents the only reported case with presenting symptoms of venous stasis ulceration in a pediatric patient.

Healing of chronic sickle cell disease-associated foot and ankle wounds using transdermal continuous oxygen therapy.

OBJECTIVE: Sickle cell disease (SCD) is a complex cause of capillary stasis that can lead to lower extremity venous ulcers. Since SCD is characterised by impaired oxygen delivery that can be exacerbated by lower extremity venous stasis, we sought to determine if direct delivery of oxygen to a lower extremity ulcer associated with SCD could augment healing. METHOD: We performed a pilot study of a portable device that delivers oxygen directly to the wound site to assess this possibility. The device was assessed in a single patient with three longstanding wounds of the lower extremities associated with SCD: the lateral right ankle, the medial aspect of the distal left leg, and the dorsal left foot. The left leg and left foot wounds received 15 weeks of treatment each. RESULTS: Both left lower extremity wounds healed, and neither wound has relapsed in the 42 months since the treatment was completed. At 36 months from the completion of treatment, the patient presented to the hospital with renal failure, and with the 27 days of complete bed rest and wound elevation, the right ankle wound shrunk to 55% of the original wound surface area. Transdermal oxygen appears to have assisted in healing and to have provided a sustained benefit that has delayed relapse of the two SCD-associated leg ulcers that received an extended course of treatment. Similarly, complete bed rest appears to aid in the healing of SCD-associated leg ulcers. Further study is needed to determine the mechanism of action and the optimal method of use of the transdermal continuous oxygen delivery device for SCD-associated lower extremity ulcers. DECLARATION OF INTEREST: No competing financial interests exist for any author. The content of this article was expressly written by the authors listed. No ghostwriters were used to write this article.

Effects of patient position on lower extremity venous pressure during different types of hysterectomy.

AIM: To explore the effects of different types of hysterectomy on lower extremity venous pressure. METHODS: Ninety-nine patients with benign uterine diseases who were indicated for hysterectomy were included in the present prospective study. Patients were divided into three groups according to their preferences: (i) total laparoscopic hysterectomy (TLH) group (n = 36); (ii) transvaginal hysterectomy (TVH) group (n = 32); and (iii) transabdominal hysterectomy (TAH) group (n = 31). Lower extremity venous pressure was monitored using a pressure sensor during the surgery. RESULTS: Compared with the supine position (TAH group, lower extremity venous pressure of intraoperative 16.50 cmH2 O), lower extremity venous pressure of the improved lithotomy position (TLH group, lower extremity venous pressure of intraoperative 53.27 cmH2 O) and conventional lithotomy position (TVH group, lower extremity venous pressure of intraoperative 42.09 cmH2 O) were significantly increased (P < 0.01).Venous pressure was reduced when patients lowered their heads by 15° or 5° in modified or conventional lithotomy positions, respectively (P < 0.01). Venous pressure was increased significantly after the establishment of pneumoperitoneum in the TLH group (P < 0.01). CONCLUSION: Modified lithotomy position (TLH group) and conventional lithotomy position (TVH group) and CO2 pneumoperitoneum may result in increased lower extremity venous pressure during hysterectomy. Furthermore, elevated venous pressure can be altered by changing the intraoperative position. Specifically, intraoperative positioning of the lower extremities represents a modifiable risk factor for deep venous thrombosis.

Heterogeneity of wound outcome measures in RCTs of treatments for VLUs: a systematic review.

OBJECTIVE: Venous leg ulcers (VLUs) affect up to 4% of the population aged over 65 years. Outcomes of randomised controlled trials (RCTs) in VLUs are important to guide clinical and resource decision making. Our objective was to identify what endpoints and wound bed outcomes were assessed in RCTs in VLUs; how these were assessed and what reference was made to validity and reliability of methods used. METHOD: A systematic review of all full text RCTs, published in English, from 1998-2013. RESULTS: Our criteria were met by 102 studies. There were 78 different endpoints recorded, the majority (n=34) related to healing and were evaluated at 12 different times points. Size was the most frequently reported outcome measure (n=99), with photographs, tissue type, exudate, odour and pain also recorded. There was poor reporting of methods used to assess outcomes. Visual analogue scales predominated as a method of assessment, but 95% of studies made no reference to the validity or reliability of assessment methods. CONCLUSION: Future research in VLUs requires standards for measuring outcomes with acceptable inter-rater reliability and validated measures of patient-reported outcomes.

Role of hyperbaric medicine for intractable leg ulcers: a case report.

We present a case report of intractable multifactorial leg ulcer that was treated successfully with multiple approaches including hyperbaric oxygen treatment (HBOT) to prepare for skin grafting. A 66-year-old female with a history of rheumatoid arthritis and Felty's syndrome presented with a non-healing ulcer on her left leg that was caused by a trauma. She failed multiple treatment options including debridement, different wound dressings, antibiotics, anti-inflammatories and vein closure procedure. She finally healed with skin graft following HBOT that prepared the wound bed before the procedure.

Usefulness of laser speckle flowgraphy for the assessment of ocular blood flow in extracranial-intracranial bypass.

Laser speckle flowgraphy (LSFG) is a noninvasive technique that can measure relative blood flow velocity in the optic fundus. The authors present a case of symptomatic internal carotid artery occlusion treated with superficial temporal artery (STA)-middle cerebral artery (MCA) bypass in which an improvement of ocular circulation was confirmed by LSFG. A 47-year-old man presented with a 1-month history of repeated left blurred vision and motor weakness of the right leg. Diffusion-weighted magnetic resonance imaging revealed a small infarction in the left frontal lobe. Carotid angiography revealed that the left internal carotid artery was occluded at the C4 portion. Single-photon emission computed tomography indicated that the cerebral blood flow in the left MCA territory was markedly impaired. Ophthalmologic examination revealed ischemic change of the left optic fundi, and LSFG revealed decreased blood flow around the left optic disc. Left STA-MCA bypass was successfully performed. Both ischemic ocular symptoms and the ischemic symptoms of the right leg were completely recovered after surgery. Postoperative ophthalmologic examination revealed improvement of both ischemic changes of the left optic fundi. Moreover, LSFG revealed improvement of the blood flow around the left optic disc. LSFG can be a promising clinical tool for the assessment of ocular circulation before and after bypass surgery for occlusive cerebrovascular disease.

[The value of radial shock wave therapy in the management of extended crural ulceration. Case report]. / A radiális lökéshullám-kezelés szerepe a nagyméretu ulcus cruris gyógyításában.

The authors present the history of a 36-year-old woman who had crural ulceration in the ventral side of the left lower limb due to venous circulatory failure for 5 years. In addition to the application of dressing adapted to the actual status of the wound, the authors applied an extracorporal shock wave therapy two times per week. After this treatment the size of the ulcer significantly decreased and it became suitable for mesh-graft cover. The patient is currently asymptomatic. The authors draw attention to the fact that the number of patients having crural ulcer is increasing in developed countries including Hungary. Lower limb ulcers occur in 1-5% of the adult population. Predisposing factors include older age and civilization hazards such as obesity, diabetes and sedentary lifestyle. The main cause of the disease is circulatory failure; venous insufficiency occurs in about two-thirds of the patients, arterial ischemia in 15% and diabetic angiopathy in 15% of the cases. Infections, metabolic diseases and immunological disorders may be also an underlying cause in a small number of patients. In several patients the causative factors occur simultaneously making difficult to find and effective treatment. Despite the use of numerous preventive and therapeutic protocols, treatment is usually long and does not always match expectations of the patients.

A case report of inadequately treated acute deep venous thrombus and venous stasis.

Background: Venous stasis dermatitis is a common skin condition that typically affects the lower extremities and may occur secondarily to venous insufficiency which can lead to a pooling of fluid within the legs. The etiology of venous stasis dermatitis is largely related to medical conditions that affect the blood flow to the lower extremities. Chronic occlusion of the common iliac veins and femoral veins can cause a lack of proper blood flow to the lower extremities. When an inferior vena cava (IVC) filter becomes tilted, it can occlude the vessels distal to its placement. Definitive treatment of chronic venous insufficiency is not common and could be improved with a referral to an interventional radiologist. Case Description: Here, we present a case of a venous stasis that is presenting secondary to chronic occlusion of the left common iliac vein and femoral vein due to a tilted and irretrievable IVC filter that was placed more than 5 years prior to presentation. Upon presentation, the patient was unable to ambulate and was suffering from large lower leg ulcers and chronic venous insufficiency secondary to the occluded vessels. The patient was treated with a series of thrombectomies in an outpatient setting until the restoration of venous blood flow was achieved. The improved venous blood flow has reduced the painful leg ulcers both in number and severity-which greatly reduces the patient's likelihood of a secondary infection. Conclusions: This case emphasizes the importance of an interdisciplinary approach to patients who may present to an outpatient dermatology clinic with signs or symptoms of acute or chronic venous insufficiency for a more definitive treatment than the current standard of care.