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Venous ulcers / edited by Cynthia K. Shortell, Jovan N. Markovic.

Elsevier ScienceDirect eBook - Biomedical Science 2023 Available online

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Format:
Book
Contributor:
Shortell, Cynthia K., editor.
Markovic, Jovan N., editor.
Language:
English
Subjects (All):
Leg--Ulcers.
Leg.
Venous insufficiency.
Venous Insufficiency.
Varicose Ulcer.
Varicose Veins.
Medical Subjects:
Venous Insufficiency.
Varicose Ulcer.
Varicose Veins.
Physical Description:
1 online resource (568 pages)
Edition:
Second edition.
Place of Publication:
London, England : Academic Press, 2023.
Summary:
Venous Ulcers, Second Edition, provides a comprehensive synthesis of evidence-based recommendations and the highest level of expertise from a leading group of doctors, which is a fundamental constituent for the appropriate management of nonhealing venous wounds in everyday practice. This book offers a fertile environment for a complete understanding of genetics and molecular and biochemical mechanisms that lead to the development and progression of venous ulcers, which is essential for elucidating the underlying pathophysiology and can be utilized for developing novel therapies and accessing previously inaccessible areas of research. Socioeconomic impact, impact on health-related quality of life, the clinical course of the disease, and diagnostic algorithms are elaborated in detail. All currently available treatment modalities are explained in a clinically applicable approach with particular emphasis on operative technique, technical feasibility, success rates (both clinical and technical), and side effects. Lastly, this book elaborates on special diagnostic considerations and management of the most complex patients, often requiring the highest level of expertise for successful treatment.
Contents:
Front Cover
Venous Ulcers
Copyright
Contents
List of contributors
Preface to Venous Ulcers
1 - Chronic venous insufficiency-basic considerations
1 - Pathophysiology of chronic venous disease: genetic, molecular, and biochemical mechanisms
Key points
Introduction
Content
Genetic predisposition for CVD and VLU
Venous structure, endothelium and glycocalyx, inflammatory cells and molecules
MMPs regulation, cellular changes, and CVD/VLU
Structural proteins and alterations in CVD and VLU
Microvenous valves and CVD
Hypoxia, apoptosis, metabolic abnormalities, and connexins in CVD/VLU
Machine learning GWAS and genetics, iron, oxidative stress, reactive oxygen/nitrogen species, biomarkers cytokines/proteoly ...
Conclusions
Acknowledgments
References
2 - Venous hemodynamics and microcirculation in chronic venous insufficiency
Hemodynamics and anatomy
Pathophysiology-superficial venous incompetence
Deep venous dysfunction
Perforating veins of the calf
Foot and calf pump function in venous hemodynamics
Microcirculation and interstitial edema
Regulation of capillary hydrostatic pressure
Blood flow and inflammation
3 - Venous ulcers of the lower extremity: etiology, risks, and predictive factors
CEAP etiologies of CVD
Secondary etiologies
Intravenous etiology
Prospective natural history studies
Epidemiologic studies
Randomized trials of DVT treatment
Extravenous etiology
Epidemiological data on CVI and its progression
The Edinburgh Vein Study50
The San Diego population study51
The Bonn Vein study52
The Polish study64
The French study53
The Italian study54
The American Venous Forum study55
The Swedish Skaraborg County studies1,56,57.
Progression of venous disease
Clinical risk factors for first VLU (Table 3.5)
Genetic risk factors for VLU
Lymphatic involvement in VLU
Summary
4 - Venous ulcers of the lower extremity: epidemiology and socioeconomic burden
Role of epidemiology in the study and treatment of venous leg ulcers
Incidence and prevalence of venous leg ulcers
Distribution of chronic venous insufficiency and its subgroups within the population
Defining venous leg ulcers
Leg ulcer prevalence
Etiologic spectrum of leg ulcers
Venous ulcer prevalence
Incidence of venous ulcers
Age and sex distribution
Socioeconomic aspects
Venous ulcer natural history
Obesity
History of DVT
Healing and survival
Future trends
2 - Clinical evaluation and diagnostic modalities
5 - Initial clinical evaluation in patients with chronic venous insufficiency
Medical history
Risk factors
Differential diagnosis of lower extremity ulcerations
Symptoms of CVI
History of prior VLU
Past treatment history
Physical exam
Signs of CVI
Assessment of the VLU
Quality of life assessment
Classification and venous severity scoring
6 - Ultrasound evaluation of lower extremity chronic venous disease
Basic principles
Diagnosis of reflux
Superficial, deep, and perforator veins
Examination protocol
Diagnosis of obstruction
Acute venous thrombosis
Chronic venous obstruction
Recurrent venous thrombosis
Imaging during and after intervention
Disclosure statement
7 - The diagnosis of major venous outflow obstruction in chronic venous insufficiency
Iliac and pelvic veins anatomy and hemodynamics.
Diagnosis of chronic venous insufficiency and venous hypertension
History and physical
Diagnostic modalities
Arterial testing
Duplex ultrasonography
CT venography
MRV
Venography
IVUS
Diagnostic algorithm
8 - Hypercoagulable states associated with chronic venous insufficiency
Protein C and protein S
Antithrombin
Factor V Leiden
Activated protein C resistance
Prothrombin G20210A gene mutations
Dysfibrinogenemia
Antiphospholipid syndrome
Paroxysmal nocturnal hemoglobinuria
Myeloproliferative neoplasms
Other hypercoagulable states that increase the risk of developing VTE and potential subsequent venous ulceration
Age
Combined oral contraceptive pill and hormone replacement therapy
Puerperium
Cancer
When and who to investigate?
Thrombophilia and post-thrombotic syndrome
Thrombophilia and venous ulceration
9 - The chronically swollen leg with ulcers-finding the cause: theory and practice
Introduction and epidemiology
Assessment of edema
Physical examination
Diagnostic studies
Laboratory test
Imaging
Goals
10 - Lower extremity wounds associated with mixed venous and arterial insufficiency and relevant differential diagnosis
Evaluation
History and physical examination
Vascular laboratory testing
Arteriography
Treatment
Differential diagnosis
Inflammatory ulcers
Infectious ulcers
Malignant ulcers
Microvascular occlusive ulcers
Pyoderma gangrenosum
11 - Assessment tools and wound documentation for patients with chronic venous insufficiency
Wound assessment tools
CEAP classification
Venous Severity Score
Revised Venous Clinical Severity Score
Venous Segmental Disease Score
Venous disability score
Quality of life measures.
QoL: SF-36
QoL: Aberdeen Varicose Vein Questionnaire
QoL: Chronic Venous Insufficiency Questionnaire
QoL: VEINES-QoL/SYM
QoL: Charing Cross Venous Ulcerations Questionnaire
Wound documentation
VLU measurements
Imaging modalities for wound assessment and measurement
Apps and cameras used for point-of-care wound measurements
Point-of-care assessment of wound perfusion
ABI, TCPO2, and SPY angiography
Diagnosis and procedure codes
3 - Nonoperative management of chronic venous insufficiency and wound care
12 - Compression therapy in venous leg ulcers
Compression devices
Medical compression stockings
Compression bandages
Interface pressure and stiffness measured on the leg
Elastic and inelastic bandages
"Single-layer" and multilayer bandages
Intermittent pneumatic compression
Pelottes and pads
Prevention of ulcer recurrence
Compression techniques-practical guidelines
13 - Wound healing: adjuvant therapy and treatment adherance
Patient and wound assessment
Standard therapies for wound bed management
General principles of wound bed management
Wound bed preparation
debridement and cleansing
Debridement
Sharp debridement
Hydrosurgical debridement
Enzymatic debridement
Biologic debridement
Cleansers and irrigation
Pain management during wound bed preparation
Wound dressings
Interactive dressings: occlusive and semi-occlusive
Wet-to-dry dressings
Hydrogel dressings
Hydrocolloid dressings
Alginates
hydrocellular foam dressings
semipermeable film dressings
Active (biologic) dressings
Growth factor therapy
Peri-wound management
Adjuvant therapy for venous ulcer wound healing
Skin grafting
Ultrasound therapy
Electrical stimulation.
Optimizing care delivery
Wound care clinics
Adherence to therapy
Treatment algorithm
14 - Negative pressure wound therapy for venous leg ulcers
NPWT description and mechanism of action
Use of NPWT in patients with VLUs
Case study
15 - Medical therapies for chronic venous insufficiency
Pathophysiology
Lifestyle considerations
Compression therapy
Compression socks
Inelastic compression garments
Paste boots
Multilayer compression bandages
The bottom line on compression
Pneumatic compression
Dietary supplements
Physical activity
Medications
Animal models
Micronized purified flavonoid fraction
Ruscus extract
Calcium dobesilate
Pentoxifylline and sulodexide
Horse chestnut
Acetylsalicylic acid
Antibiotics
Biologic wound care products
Guidelines
16 - Treatment modalities for the management of nonhealing wounds in patients with chronic venous insufficiency
Lifestyle modification
Medical therapy
Untreated arterial or deep venous disease
Compression
Identification and treatment of infection
Dressings and local agents
External stimulants
Skin grafting, skin substitutes, and soft tissue substitutes
Conclusion
17 - Deep vein thrombosis and prevention of postthrombotic syndrome
Anatomic considerations in PTS
Hemodynamics of PTS
Collateralization and flow patterns in acute DVT
Phlegmasia cerulea dolens
Microcirculation and capillary exchange
Anticoagulation to prevent PTS
Venoactive drugs
Elastic compression therapy
Thrombolysis/endovascular therapies to prevent PTS
Surgical thrombectomy
Our experience
A case study
Open surgical reconstructions
Ultrasound-accelerated thrombolysis.
Venous ulcer care.
Notes:
Description based on print version record.
Includes bibliographical references and index.
Other Format:
Print version: Shortell, Cynthia K. Venous Ulcers
ISBN:
9780323906104
9780323985871
0323985874

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