cardiovascular-agents and Varicose-Ulcer

Venous leg ulcers (VLUs) are the most severe manifestation of chronic venous disease (CVD). Due to their chronic nature, high recurrence rate and slow healing time, VLUs account for 80% of all leg ulcers seen in patients with CVD. VLUs impose a heavy burden on patients that reduces their quality of life; VLUs also represent a major socioeconomic impact due to the cost and duration of care. The primary medical approach to treating VLUs is local compression therapy in combination with venoactive drug (VAD) pharmacotherapy to promote the reduction of the inflammatory reaction initiated by venous hypertension. Micronized purified flavonoid fraction (MPFF; Daflon

Topics: Cardiovascular Agents; Chronic Disease; Compression Bandages; Diosmin; Flavonoids; Humans; Quality of Life; Severity of Illness Index; Varicose Ulcer; Wound Healing

Venous disease is common in Latin America, with an estimated 68.11% prevalence of chronic venous disease. The diverse social, political, and economic characteristics of the many nations that make up Latin America mean that different conditions affect how these diseases are diagnosed and treated, which may differ markedly from the way they are treated by the health care systems of the United States and Europe. Our goal was to review the current state of treatment of chronic venous insufficiency (CVI) in Latin America.. This is a narrative review of the medical literature on the subject and synthesizes sometimes fragmentary information on CVI across a large and diverse region.. CVI represents an unmet medical need in Latin America. Conservative treatments, such as compression stockings, may be used at first, and there are nonpharmacologic and complementary and alternative medicine approaches in use. Endovenous approaches, such as endovenous thermal ablation, have largely replaced surgical interventions. In Europe and the United States, such procedures are mainly carried out in ambulatory facilities, whereas they are mainly performed in the hospital in Latin America.. Recent strong economic growth in Latin America and improvements in social security and health care suggest that innovative approaches to chronic venous disease and CVI will be implemented.

Topics: Ablation Techniques; Aged; Aged, 80 and over; Cardiovascular Agents; Chronic Disease; Endovascular Procedures; Female; Humans; Latin America; Male; Sclerotherapy; Stockings, Compression; Treatment Outcome; Varicose Ulcer; Venous Insufficiency

This goal of this study was to systematically review the literature to determine if surgical intervention (open or endovascular) is superior to compression alone with respect to ulcer healing, ulcer recurrence, and time to ulcer healing in patients with lower extremity venous ulcer disease.. We conducted a comprehensive search of multiple databases for randomized controlled trials (RCTs) and comparative observational studies from 1990 to December 2013. The interventions of interest were any open or endovascular surgical interventions on the venous system in the lower extremity compared with compression alone.. We included 11 studies (seven RCTs and four observational studies) with moderate to increased risk of bias. The meta-analysis of all studies demonstrated increased healing rate (pooled risk ratio [RR], 1.06; 95% confidence interval [CI], 1.00-1.13; I(2) = 10%) and lower risk of recurrence (RR, 0.54; 95% CI, 0.34-0.85; I(2) = 27%) with open surgical procedures compared with compression. However, the meta-analysis of only RCTs showed no difference, possibly due to imprecision. The meta-analysis of three RCTs showed no difference in time to ulcer healing, -0.41 (95% CI, -0.89 to 0.07). Two studies of endovascular surgical procedures compared with compression showed no significant difference in ulcer healing (RR, 1.65; 95% CI, 0.43-6.32). One study of open surgical venous ligation and stripping compared with endovenous laser also showed no significant difference in ulcer recurrence (RR, 0.83; 95% CI, 0.21-3.27).. Open surgical interventions may improve lower extremity venous ulcer healing. The quality of this evidence is low because the analysis was dominated by the results of observational studies. The current evidence does not definitively support the superiority of endovascular surgical interventions compared with compression alone.

Topics: Cardiovascular Agents; Compression Bandages; Endovascular Procedures; Humans; Odds Ratio; Recurrence; Risk Factors; Time Factors; Treatment Outcome; Varicose Ulcer; Vascular Surgical Procedures; Wound Healing

Topics: Cardiovascular Agents; Compression Bandages; Diagnostic Techniques, Cardiovascular; Endovascular Procedures; Evidence-Based Medicine; Humans; Predictive Value of Tests; Societies, Medical; Treatment Outcome; Varicose Ulcer; Vascular Surgical Procedures; Wound Healing

Venous ulcers continue to cause problems for patients and health care systems. These are painful and unpleasant for the patient and expensive for health care providers to treat. This brief review highlights effective methods of management. There is level 1 evidence of the efficacy of compression (bandaging or stockings) in healing ulcers as well as maintaining healing. Patients with superficial saphenous reflux, with or without perforating and deep vein incompetence, benefit from superficial venous surgery. This does not speed ulcer healing but is effective at preventing recurrence after healing with compression. Minimally invasive methods of managing incompetence of superficial saphenous trunks, including endovenous laser ablation, radiofrequency ablation, and foam sclerotherapy are probably also effective in treating patients with venous leg ulcers. Perforating vein ligation is commonly combined with superficial venous surgery for leg ulcer patients, but no systematic data are available to define the role of this treatment. Some centers use deep vein reconstruction to restore competence to deep vein valves. Insufficient data have been published to allow any general recommendation to be made for this treatment. A limited number of drugs have efficacy in promoting leg ulcer healing. They may be used in combination with compression treatment in patients with ulcers refractory to other methods of management. No particular ulcer dressing has been shown to be effective in speeding ulcer healing.

Topics: Bandages; Cardiovascular Agents; Catheter Ablation; Combined Modality Therapy; Evidence-Based Medicine; Humans; Laser Therapy; Leg Ulcer; Ligation; Practice Guidelines as Topic; Sclerotherapy; Stockings, Compression; Treatment Outcome; Varicose Ulcer; Vascular Surgical Procedures; Wound Healing

Venous ulcers affect almost 1 million people in the United States. Delayed healing and frequent recurrence result in pain, disability, decreased quality of life, and loss of working days for the patients. Compression therapy is the most effective treatment of ulcers, but compliance with conservative treatment is important, and recurrence must be prevented by treating the underlying ambulatory venous hypertension. Evidence from prospective randomized trials confirm that ulcer recurrence is decreased with superficial vein surgery. Evidence is also increasing about the superiority of endovenous interventions, such as laser or radiofrequency ablation, over the classic open surgical treatment of high ligation, division, and stripping of the saphenous vein. Well-conducted randomized trials are still needed to provide grade A evidence to justify treatment of incompetent perforating veins. Treatment of proximal venous occlusion is important, and venous stents have been effective and durable. Open surgery is only considered today for iliac or iliocaval venous obstruction if endovascular treatment is not possible or has already failed. Open surgery for deep venous incompetence is recommended in centers of excellence, although evidence to support its effectiveness is of low quality.

Topics: Cardiovascular Agents; Evidence-Based Medicine; Humans; Practice Guidelines as Topic; Secondary Prevention; Stockings, Compression; Time Factors; Treatment Outcome; Varicose Ulcer; Vascular Surgical Procedures; Wound Healing

In terms of prevalence, total cost and morbidity, venous leg ulcers are probably by far the most important type of ulcerations in the leg. The macrocirculatory defect leading to a raised ambulatory venous pressure is now accepted as a common initial pathologic pathway. Most current treatment modalities, such as surgery or external compression, are designed to control the macrovascular defect. However, it is the microcirculatory consequences of the venous hypertension that give rise to the trophic skin changes and ultimately to ulceration. At this microcirculatory level, pharmacotherapy may be a useful adjunct in the treatment of venous leg ulcers. The microcirculatory pathophysiologic changes include decreased fibrinolytic activity, elevated plasma fibrinogen, microcirculatory thrombi, and inappropriate activation of the white blood cells. The oxidative burst from the activated white cells probably plays a key role by releasing locally leukocyte-derived free radicals, proteolytic enzymes, cytokines, platelet-activating factor, and a number of other noxious mediators. An important additional component in recalcitrant venous ulcers is co-existing arterial disease, which is probably present in 15-20% of cases. Decreased arterial perfusion pressure will further aggravate the ischemic changes caused by the venous hypertension. Pentoxifylline downregulates leukocyte activation, reduces leukocyte adhesion, and also has fibrinolytic effects. A number of clinical studies have therefore been carried out to examine the clinical efficacy of pentoxifylline in treatment of venous leg ulcers. Probably the largest published placebo-controlled, double-blind randomized study was reported in 1990. In this study, 80 patients received either pentoxifylline 400 mg three times a day orally or matching placebo for 6 months or until their reference ulcer healed if this occurred sooner. Complete healing of the reference ulcer occurred in 23 of the 38 patients treated with pentoxifylline compared to 12 of the 42 patients treated with placebo. The odds ratio in favor of pentoxifylline was 1.81 (95 confidence intervals 1.20-2.71).

Topics: Cardiovascular Agents; Humans; Varicose Ulcer

Venous leg ulcers (VLUs) can take many months to heal and 25% fail to heal. The main treatment for venous leg ulcers is compression therapy and few additional therapies exist. Two previous trials indicated that low-dose aspirin may improve healing time, but these trials were insufficiently robust.. A multi-centred, pilot, phase II, randomised, double blind, parallel-group, placebo-controlled, efficacy trial (RCT) was conducted to determine: if aspirin improves VLU healing time; the safety of aspirin in this population; treatment compliance; and the feasibility of recruitment to a phase III trial. We recruited patients from secondary care who were aged ≥ 18 years, had a chronic VLU and not regularly taking aspirin. Participants were randomly assigned (1:1) to receive 300 mg of daily aspirin or placebo in addition to standard care, which consisted of multi component compression therapy aiming to deliver 40 mmHg at the ankle where possible. The randomisation list was stratified by ulcer size (≤ 5 cm. Twenty-seven patients were recruited from eight sites (target 100 patients). A short time-frame to recruit and a large number of patients failing to meet the eligibility criteria were the main barriers to recruitment. There was no evidence of a difference in time to healing of the reference ulcer following adjustment for log ulcer area and duration (hazard ratio 0.58, 95% confidence interval 0.18 to 1.85; p = 0.357). One expected serious adverse event related to aspirin was recorded. A number of options to improve recruitment were explored.. There was no evidence that aspirin was effective in expediting the healing of chronic VLUs. However, the analysis was underpowered due to the low number of participants recruited. The trial design would require substantial amendment in order to progress to a phase III (effectiveness) trial.. Clinicaltrials.gov, NCT02333123. Registered on 5 November 2014.

Topics: Adult; Aged; Aged, 80 and over; Aspirin; Cardiovascular Agents; Compression Bandages; Double-Blind Method; Female; Humans; Male; Middle Aged; Pilot Projects; Time Factors; Treatment Outcome; United Kingdom; Varicose Ulcer; Wound Healing

Although the standard treatment for venous ulcers is compression, drugs may be used as adjunctive therapy. Simvastatin has shown potential wound-healing properties; however, no studies have investigated its use in venous ulcers.. To assess the efficacy and safety of simvastatin in venous ulcer healing when combined with standard treatment for ulcers.. This was a randomized, double-blind, placebo-controlled trial. Outcome measures were the proportion of healed ulcers, healing time, total surface area healed and Dermatology Life Quality Index (DLQI) scores.. Sixty-six patients were randomized into two groups: a simvastatin (n = 32) and a control (n = 34) group. Among ulcers ≤ 5 cm, 100% were healed in the simvastatin group, and 50% were healed in the control group [relative risk (RR) 0·10, 95% confidence interval (CI) 0·0141-0·707]. The average healing times for ulcers ≤ 5 cm were 6·89 ± 0·78 weeks and 8·40 ± 1·13 weeks for the simvastatin and control groups, respectively (P < 0·001). Among ulcers > 5 cm, 67% closed in the simvastatin group, with a mean healing time of 9·17 ± 1·07 weeks. No ulcers of this size closed in the control group (RR 0·33, 95% CI 0·132-0·840). The simvastatin group had lower DLQI scores (P < 0·001) post-treatment. No adverse effects were documented.. Simvastatin 40 mg daily, in addition to standard wound care and compression, is associated with a significant improvement in healing rate and time, as well as an improved patient quality of life when compared with placebo in the management of venous ulcers.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Cardiovascular Agents; Dermatologic Agents; Double-Blind Method; Female; Humans; Male; Middle Aged; Simvastatin; Treatment Outcome; Varicose Ulcer; Wound Healing; Young Adult

To determine the effect of aspirin on ulcer healing rate in patients with chronic venous insufficiency, and to establish prognostic factors that influence ulcer evolution.. Between 2001 and 2005, 78 patients with ulcerated lesions of diameter >2 cm and associated with chronic venous insufficiency were evaluated in our hospital. Of these, 51 patients (22 men, 29 women) with mean age of 60 years (range: 36-86) were included in a prospective randomized trial with a parallel control group. The treatment group received 300 mg of aspirin and the control group received no drug treatment; in both groups, healing was associated with standard compression therapy. During follow-up, held weekly in a blinded fashion, there was ulcer healing as well as cases of recurrence. Results were analyzed by intention-to-treat approach. Cure rate was estimated using Kaplan-Meier survival analysis, and the influence of prognostic factors was analyzed by applying the Cox proportional hazards model.. In the presence of gradual compression therapy, healing occurred more rapidly in patients receiving aspirin versus the control subjects (12 weeks in the treated group vs. 22 weeks in the control group), with a 46% reduction in healing time. The main prognostic factor was estimated initial area of injury (P = 0.032). Age, sex, systemic therapy, and infection showed little relevance to evolution.. The administration of aspirin daily dose of 300 mg shortens the healing time of ulcerated lesions in the chronic venous insufficiency (CVI). The main prognostic factor for healing of venous ulcerated lesions is the initial surface area of the ulcer.

Topics: Adult; Aged; Aged, 80 and over; Aspirin; Bandages, Hydrocolloid; Cardiovascular Agents; Chi-Square Distribution; Chronic Disease; Combined Modality Therapy; Compression Bandages; Debridement; Drug Administration Schedule; Female; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Proportional Hazards Models; Prospective Studies; Recurrence; Risk Assessment; Risk Factors; Spain; Time Factors; Treatment Outcome; Varicose Ulcer; Venous Insufficiency; Wound Healing

To estimate the usefulness of therapeutic ultrasound for healing of venous leg ulcers.. Eighty-one patients were included in this study. Patients in groups 1 and 2 were treated surgically. Patients in groups 3 and 4 were treated conservatively. Patients in groups 1 and 3 were additionally treated with the ultrasound (1 MHz, 0.5 W/cm(2)) once daily, six times a week for seven weeks.. Comparison of the number of complete healed wounds indicated statistically significant differences between groups 1 and 4 (P = 0.03), 2 and 4 (P = 0.03), 3 and 4 (P = 0.03) in favour of groups 1, 2 and 3. Comparison of the other parameters also demonstrated more efficient therapy effects in groups 1, 2 and 3 than in group 4. There were no statistical differences in all examined parameters between groups 1, 2 and 3 (P > 0.05).. The ultrasound is an efficient and useful method only in conservatively treated venous leg ulcers. There are no special reasons for application of the ultrasound in surgically treated patients. A well-conducted surgical operation is much more effective for a healing process than conservative pharmacological procedures.

Topics: Adult; Aged; Aged, 80 and over; Cardiovascular Agents; Combined Modality Therapy; Female; Humans; Male; Middle Aged; Patient Selection; Poland; Stockings, Compression; Time Factors; Treatment Outcome; Ultrasonic Therapy; Varicose Ulcer; Vascular Surgical Procedures; Wound Healing

Topics: Cardiovascular Agents; Dermatologic Agents; Female; Humans; Male; Simvastatin; Varicose Ulcer

Adding simvastatin to standard wound care improves ulcer healing rates and times as well as the patient's quality of life.

Topics: Cardiovascular Agents; Dermatologic Agents; Female; Humans; Male; Simvastatin; Varicose Ulcer

Topics: Biopsy; Cardiovascular Agents; Debridement; Fasciotomy; Humans; Quality of Life; Skin; Stockings, Compression; Varicose Ulcer; Venous Insufficiency; Wound Infection

Topics: Cardiovascular Agents; Compression Bandages; Endovascular Procedures; Evidence-Based Medicine; Humans; Practice Guidelines as Topic; Societies, Medical; Treatment Outcome; Varicose Ulcer; Vascular Surgical Procedures; Wound Healing

Topics: Cardiovascular Agents; Chronic Disease; Compression Bandages; Evidence-Based Medicine; Humans; Sclerotherapy; Treatment Outcome; Varicose Ulcer; Vascular Surgical Procedures; Venous Insufficiency; Wound Healing

Topics: Cardiovascular Agents; Coumarins; Drug Therapy; Flavonoids; Humans; Lymphedema; Muscle Cramp; Paresthesia; Varicose Ulcer; Varicose Veins

Topics: Adrenal Cortex Hormones; Cardiovascular Agents; Glucocorticoids; Humans; Hydrocortisone; Pregnadienes; Varicose Ulcer

Topics: Cardiovascular Agents; Ergoloid Mesylates; Ergot Alkaloids; Humans; Ulcer; Varicose Ulcer; Varicose Veins; Veins