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At least 19 recordsLinked to original sources
PubMed2003

Micronised purified flavonoid fraction: a review of its use in chronic venous insufficiency, venous ulcers and haemorrhoids.

Micronised purified flavonoid fraction (MPFF) [Daflon 500 mg], an oral phlebotropic drug consisting of 90% micronised diosmin and 10% flavonoids expressed as hesperidin, improves venous tone and lymphatic drainage, and reduces capillary hyperpermeability by protecting the microcirculation from inflammatory processes. The absorption of diosmin is improved by its micronisation to particles with a diameter <2 microm. Compared with placebo, MPFF 500 mg twice daily significantly decreased ankle or calf circumference, and improved many symptoms of chronic venous insufficiency (CVI) and plethysmographic parameters in two randomised, double-blind, 2-month studies. Improvement in symptoms was parallelled by an improvement in health-related quality of life in a nonblind, 6-month trial. Significantly more venous leg ulcers </=10 cm in diameter completely healed with MPFF 500 mg twice daily plus standard management (compression and local treatment) for 2-6 months than with standard management alone or with placebo in a nonblind and a double-blind trial. The addition of MPFF to standard management was cost effective in a retrospective pharmacoeconomic analysis of the 6-month trial. Compared with placebo, the duration and/or intensity of individual symptoms of grade 1 or 2 acute internal haemorrhoids improved significantly with 3 tablets of MPFF 500 mg twice daily for 4 days then 2 tablets of MPFF 500 mg twice daily for 3 days. Two tablets of MPFF 500 mg daily for 60 or 83 days reduced the frequency, duration and/or severity of acute haemorrhoidal symptoms and improved the overall signs and symptoms of chronic (recurrent) haemorrhoids compared with placebo. Compared with a control group, MPFF significantly reduced the risk of secondary bleeding after elective haemorrhoidectomy. In clinical trials, MPFF had a tolerability profile similar to that of placebo; the most frequently reported adverse events were gastrointestinal and autonomic in nature. In conclusion, MPFF is a well established and well tolerated treatment option in patients with CVI, venous ulcers, or acute or chronic internal haemorrhoids. MPFF is indicated as a first-line treatment of oedema and the symptoms of CVI in patients in any stage of the disease. In more advanced disease stages, MPFF may be used in conjunction with sclerotherapy, surgery and/or compression therapy, or as an alternative treatment when surgery is not indicated or is unfeasible. The healing of venous ulcers </=10 cm in diameter is accelerated by the addition of MPFF to standard venous ulcer management. MPFF may reduce the frequency, duration and/or intensity of symptoms of grade 1 or 2 acute internal haemorrhoids, and also the severity of the signs and symptoms of chronic haemorrhoids.

Administration, Oral↗
PubMed1985

[Photoplethysmography in chronic venous insufficiency].

Venous photoplethysmography (P.P.G.) is a non-invasive diagnostic technique using reflection of infrared light on the skin. The record gives a curve analogous to venous pressure. Normally the venous pressure of the leg decreases in response to calf muscle exercise. We have affixed the P.P.G. transducer to the skin above the medial malleolus and have analyzed the recovery half time (T 1/2) on 170 limbs: 49 normal, 82 with superficial venous insufficiency and 39 with deep venous insufficiency. Reference tests were ascending and retrograde phlebography and venous Doppler evaluation. A tourniquet was used to occlude the superficial venous network. T 1/2 without tourniquet is useful to screen limbs with venous insufficiency. T 1/2 with tourniquet differentiates deep and superficial venous insufficiency. P.P. G. can document the rise of deep venous insufficiency in patients with varicose veins and or repermeation of deep veins or post phlebitic syndrome among patients who have had thrombophlebitis.

Chronic Disease↗
PubMed1991

Repair and replacement of deep vein valves in the treatment of venous insufficiency.

Venous insufficiency is a widespread condition, the prevalence of venous ulceration being 0.5-1.0 per cent in Western populations. A principal abnormality causing venous insufficiency is deep venous reflux, usually resulting from post-thrombotic valve destruction. Patients undergoing treatment for venous insufficiency should have all venous abnormalities investigated, defined and corrected where possible. Although treatment for superficial and communicating vein incompetence is available, correction of deep vein reflux has been neglected until recently. Deep vein valve physiology, the selection of patients for deep vein valve surgery and methods of valve repair and replacement are reviewed.

Animals↗
PubMed2005

Superficial vein surgery and SEPS for chronic venous insufficiency.

Venous insufficiency in its severe forms leads to skin changes which, in turn may be treated by surgical therapy. Interventions are directed towards correction of the underlying abnormal venous physiology. This involves removal of varicose veins and ablation of incompetent axial veins and relevant perforating veins. In performing ablation of saphenous vein reflux, techniques include high ligation with stripping, radiofrequency ablation, endovenous laser therapy, and foam sclerotherapy. Incompetent perforator interruption can be accomplished surgically by subfascial endoscopic perforator surgery (SEPS) or controlled sclerotherapy using ultrasound. A variety of techniques have emerged to manage the varicose veins themselves. Surgical treatment of chronic venous insufficiency with high ligation in the groin and inversion stripping of the great saphenous vein to the knee combined with stab avulsion of varicose veins continues to be the standard in treatment of varicose veins. There are few comparisons of sclerotherapy of perforating veins with SEPS, but SEPS has become the most popular of surgical options.

Angioscopy↗
PubMed1996

A new method for the assessment of tissue hemoglobin oxygenation in patients with chronic venous insufficiency.

Venous incompetence often leads to ulceration of the skin of the lower limb due to a disturbance of skin microcirculation. We investigated 10 healthy subjects and 18 patients with chronic venous insufficiency by means of a fast scanning reflection photometer and determined noninvasively the hemoglobin oxygen saturation (S(HB)) and the relative concentration of hemoglobin (C(HB)) in the skin of the forefoot and at the calf, 10 cm proximal of the inner malleolus during positional changes. In supine position no significant differences were found. During sitting and standing S(HB) dropped and was significantly lower in patients at both locations (calf, standing, patients 22.2 +/- 10.6% vs controls 48.2 +/- 13.5%, P < 0.001). C(HB) increased in patients during standing from 0.71 to 2.13 +/- 0.33 aU (in controls from 0.69 to 1.49 +/- 0.28 aU, P < 0.001). Activation of the muscle pump decreased C(HB) and increased S(HB) in patients and in controls. After the movements were stopped, S(HB) decreased again and fell to the initial low values eight times faster in patients (7.4 +/- 5.3 vs 57.5 +/- 19.6 sec, P < 0.001). C(HB) increased four times faster in patients (7.2 +/- 6.1 vs 29.9 +/- 13.6 sec). In sitting and standing positions hemoglobin oxygenation in the skin of the lower limb was markedly reduced in patients, but normal perfusion conditions were restored in supine position, indicating reversibility of the changes. Reflection oxymetry seems a valuable tool for the assessment of chronic venous insufficiency. The substantially reduced oxygenation of dermal hemoglobin in standing patients may contribute to the development of venous ulcers.

Adult↗
PubMed2001

Chronic venous insufficiency and venous leg ulceration.

UNLABELLED: Venous ulcers are the most common form of leg ulcers. Venous disease has a significant impact on quality of life and work productivity. In addition, the costs associated with the long-term care of these chronic wounds are substantial. Although the exact pathogenic steps leading from venous hypertension to venous ulceration remain unclear, several hypotheses have been developed to explain the development of venous ulceration. A better understanding of the current pathophysiology of venous ulceration has led to the development of new approaches in its management. New types of wound dressings, topical and systemic therapeutic agents, surgical modalities, bioengineered tissue, matrix materials, and growth factors are all novel therapeutic options that may be used in addition to the "gold standard," compression therapy, for venous ulcers. This review discusses current aspects of the epidemiology, pathophysiology, clinical presentation, diagnostic assessment, and current therapeutic options for chronic venous insufficiency and venous ulceration. (J Am Acad Dermatol 2001;44:401-21.) LEARNING OBJECTIVE: At the conclusion of this learning activity, participants should be familiar with the 3 main types of lower extremity ulcers and should improve their understanding of the epidemiology, pathogenesis, risk factors, clinical presentation, diagnostic assessment, and current therapies for chronic venous insufficiency and venous ulcers.

Anti-Bacterial Agents↗
PubMed1991

[Physiopathology of erectile dysfunction due to cavernous venous insufficiency].

Venous insufficiency can cause impotence even in the presence of a normal arterial blood supply. This venous leak may be due to disorders of cavernous tissue (smooth muscle degeneration), disorders of the albuginea (poor compression of the perforating veins), neurotransmitter disturbances or autonomic nervous system disorders. All of these causes result in a pathological venous leak with a raised maintenance flow and abnormal cavernography.

Erectile Dysfunction↗
PubMed1997

Chronic venous insufficiency and venous ulceration.

OBJECTIVE: To review and summarize the literature on the normal venous circulation of the leg, and the epidemiology, pathophysiology, and treatment of chronic venous insufficiency (CVI). DATA SOURCES: English-language articles identified through a MEDLINE search (1966-1996) using the terms venous insufficiency or varicose ulcer and epidemiology, pathophysiology, diagnosis, and clinical trial (pt), and selected cross-references. STUDY SELECTION: Articles on epidemiology, pathophysiology, and treatment of CVI. Randomized, controlled studies were specifically sought for treatment efficacy. DATA EXTRACTION: Data were manually extracted from selected studies and reviews: emphasis was placed on information relevant to the general internist. DATA SYNTHESIS: Chronic venous insufficiency is a common primary care problem associated with significant morbidity and health care costs. The clinical spectrum of disease ranges from minor cosmetic concerns to severe fibrosing panniculitis and ulceration. Duplex Doppler ultrasonography may be the single best test to rule out deep venous thrombosis and other entities that can mimic CVI. Leg elevation and compression stockings are effective treatments for CVI; recalcitrant cases may require intermittent pneumatic compression. Topical antiseptics, antibiotics, enzymes, or growth factors offer no clear advantages in ulcer healing. Ulcer dressings remain a matter of convenience, cost, and physician judgment. The role of surgery in CVI appears to be limited. CONCLUSIONS: Chronic venous insufficiency is a recalcitrant, recurrent medical problem. This condition can be managed by primary care physicians with relatively inexpensive treatment modalities in association with lifestyle modification.

Chronic Disease↗
PubMed2001

Prevalence and risk factors of chronic venous insufficiency.

Venous disease in the legs occurs very commonly in the general population in Western countries. Around one third of women have trunk varices. A lower prevalence has been observed in men but some recent surveys have suggested that the occurrence in men may be comparable to that in women. The prevalence increases with age but the incidence of new cases appears to be constant throughout adult life. Open venous ulcers occur in about 0.3% of the adult population and a history of open or healed ulceration occurs in around 1%. The etiology of chronic venous disease in the legs is unknown. A genetic predisposition may be present but evidence for this and for a mode of inheritance is lacking. There is some suggestion that prolonged standing may be a risk factor but studies are open to considerable bias. In women, obesity and previous pregnancy has been associated with the presence of varicose veins but the evidence is inconsistent. There have been few well-conducted studies examining diet and bowel habit as a risk factor. The risk of ulceration is related to the severity of varicosities and venous insufficiency, and is increased following deep vein thrombosis. Much further research is required to investigate the cause of this common condition in the general population.

Adult↗
PubMed1991

Drug treatment of chronic venous insufficiency and venous ulceration: a review.

Treatment of venous insufficiency and venous ulceration has for many years relied on established principles of compression and limb elevation. Drug treatment has been of little benefit. In recent years, a better understanding of the pathological mechanisms underlying skin damage in venous disease has allowed more rational pharmacotherapeutic approaches to be made. This review examines these, with special reference to current theories of the cause of venous ulceration.

Anti-Bacterial Agents↗
PubMed2003

A systematic review of pneumatic compression for treatment of chronic venous insufficiency and venous ulcers.

INTRODUCTION: As part of a reconsideration of coverage policy, the Centers for Medicare and Medicaid Services requested a systematic review of the evidence on the use of pneumatic compression devices in the home environment for treatment of chronic venous insufficiency (CVI) and venous ulcers. METHODS: Articles were found with a systematic literature search of MEDLINE, EMBASE, and AMED (Allied and Complementary Medicine) databases, hand searches of reference lists, and suggestions of experts. RESULTS: Eight trials that met the inclusion criteria, including several randomized control trials, were found. Most studies were small and may have been underpowered. However, several were well-designed randomized controlled trials. Three studies showed that the devices could alleviate symptoms of CVI. No studies directly measured whether the devices could prevent the occurrence of venous ulcers. Some studies on the treatment of venous ulcers did not show a benefit for pneumatic compression, but other studies showed a benefit for the devices in healing long-standing chronic ulcers that had not healed with other methods. No studies directly compared single-chamber and multiple-chamber devices or studied whether the effectiveness of the pump was dependent on types of treatment used concurrently with the pump. Few adverse events were reported in the trials. Patients generally expressed satisfaction with the pneumatic compression devices, and several studies reported higher compliance than with other compression methods. CONCLUSION: The available data cannot be relied on to inform the optimal choice of compression therapy or optimal protocol for patients with CVI or venous ulcers. Methodologically rigorous research designed to answer these questions would be useful for treatment decisions. The Centers for Medicare and Medicaid Services considered the results of this study and issued a decision that pneumatic compression will only be covered for patients with refractory edema with significant ulceration of the lower extremities after a 6-month trial of standard therapies, such as compression stockings, has failed.

Chronic Disease↗
PubMed1998

The 4 rights of compression therapy for patients with chronic venous insufficiency and venous ulceration.

Compression therapy has become an ever increasing component in the care of patients with Chronic Venous Insufficiency (CVI) and venous ulcerations. Although compression therapy is of great benefit to many of these patients, this treatment option does not come without risks. The increased use of compression therapy has coincided with an increase in its improper application. This article simplifies the principles of compression and highlights the common pitfalls of its use, with an emphasis on the home healthcare setting.

Bandages↗
PubMedDate not supplied

HR, 0-(beta-hydroxyethyl)-rutosides, in comparison with diosmin+hesperidin in chronic venous insufficiency and venous microangiopathy: an independent, prospective, comparative registry study.

The aim of this independent study was to investigate differences in efficacy between HR, (0-[beta-hydroxyethyl]-rutosides) and D+H (500 mg, diosmin+hesperidin) in patients with chronic venous insufficiency (CVI). A first group of 90 patients with severe venous hypertension (CVI, ankle swelling) were randomized into an HR or a D+H group. The HR group received oral HR (2 g/day, 8 weeks); the D+H group received a 500 mg tablet 3 times daily for 8 weeks. A second group of comparable patients was included in a registry following the same study format. Patients were openly included; the 2 treatments were administered with the same methods and procedures. Clinical conditions were comparable to those described in the randomized study. Patients treated for at least 8 weeks were included in the registry. A number of physicians (specialists or general practitioners) included patients when they considered that clinical conditions were compatible with using 1 of the 2 treatments on the basis of their personal evaluation and experience. When cases were compatible with the registry, the prescribing physician communicated the case. Patients were evaluated without interfering with the treatment. Main targets of evaluation were skin flux at rest (RF), strain-gauge-derived rate of ankle swelling (RAS), and analogue symptoms score (ASLS). Ninety subjects completed the study in the first group; 122 in the second, registry group (total of 212 patients). The first and second (registry) groups and the 2 treatment groups were comparable for age and sex distribution. The pooled mean age was 42 years (SD +/-5.5) in the HR group (46+62 patients) and 41.5 (SD +/-6) in the D+H group (44+60 patients). Considering pooled data there were no differences in microcirculatory parameters between the pooled treatment groups at inclusion. A significant decrease (p<0.05) in RF and RAS was observed in the HR group at 8 weeks. The decrease in resting skin flux and in capillary filtration was associated with a significant improvement in signs/symptoms (analogue scale line) from an average of 9.4 (range 3-10) to 3.3 (4-6) (p<0.05). Significantly smaller variations were observed in the D+H group. The decrease in RF was 47.6% in the HR group vs 15.7% in the D+H group. The decrease in RAS was 40.9% in the HR group vs 12.8% in the D+H group. The decrease in ASLS was 64.8% in the HR group vs 12.9% in the comparative group. In conclusion venous microangiopathy and edema were improved by the treatment with HR both in the randomized study and in the pooled analysis. The comparison with D+H indicates that HR is comparatively more effective both on microcirculatory parameters and on signs/symptoms of CVI.

Administration, Oral↗
PubMed2005

Evaluation of venous insufficiency.

"Venous disease consists of a spectrum with significant medical and economic morbidities. For lack of exposure, however, it is a poorly understood subject. The evaluation and approach to diagnosing venous disease requires a firm understanding of venous anatomy and pathophysiology. With a targeted history and physical, and noninvasive testing, venous disease may be evaluated comprehensively."

Algorithms↗
PubMedDate not supplied

[Drug therapy of venous insufficiency].

Venous pharmacotherapy is a subject which, up to now, has not been submitted to rigorous scientific investigation as we currently lack in vivo observation methods. We can oppose direct actions stemming from sympathic stimulation and tissular mediators to the indirect actions of the substances which affect the arteriolar circulation or arterio-venous anastomoses. Anthocyanosides are amongst the most important of all the drugs acting on the permeability of the membrane. Dihydroergotamine, which has revived old controversies about the vegetative innervation of vein walls, has proved to have an increasing effect on venous pressure in clinostatism. We have ourselves witnessed this venotonic action of subjects in the supine position. In an upright position there have not been any reactions of hypertension, perhaps because of the hypertonic effect obtained naturally from the bard receptors which prevail on the pharmacological effect.

Dihydroergotamine↗
PubMed1988

Correlation of clinical findings with venous hemodynamics in 386 patients with chronic venous insufficiency.

Deep venous insufficiency secondary to deep valvular incompetence predominated over superficial venous insufficiency in an unselected patient population with advanced chronic venous insufficiency. Venous obstruction was uncommon (5 percent), suggesting that venous bypass surgery may have limited applicability in the management of chronic venous insufficiency. Although the majority of patients (72 percent) with stage III venous disease (ulcer) had deep venous insufficiency alone and would be potential candidates for deep valvular reconstruction, 13 percent were found to have superficial venous insufficiency alone, and the remaining 15 percent, deep venous insufficiency with a hemodynamically significant component of superficial venous insufficiency. These findings suggest that not all patients with stage III disease have altered hemodynamics on the basis of deep venous valvular incompetency. Although most stage III chronic venous insufficiency is secondary to altered deep venous hemodynamics, as demonstrated by shortened venous refill time, there is a significant group of patients with severe chronic venous insufficiency having superficial venous insufficiency alone or in combination with deep venous insufficiency (28 percent). Thus, it is imperative that those patients with superficial venous insufficiency be identified by a widely available and reproducible method, such as light reflection rheography, since they may respond to surgery of the superficial venous system alone.

Adolescent↗