DISEASE EDUCATION SUPERFICIAL VEIN THERAPIES
Information about venous reflux disease
Information about venous reflux disease
Venous reflux disease or chronic venous insufficiency (CVI) is a progressive medical condition that may worsen over time and affects the veins and vessels in the leg that carry oxygen-poor blood back toward the heart. Signs and symptoms may include pain, swelling and fatigue of the legs as well as skin damage and ulcers. CVI is often preceded by varicose veins.¹
With proper treatment, the progressive symptoms of venous reflux disease are preventable.
Without treatment, signs and symptoms may progress and significantly impact quality of life, and lead to venous leg ulcers.
Venous leg ulcers can be caused by chronic venous insufficiency (CVI).4 This can be caused by reflux in any of the venous systems — superficial, perforator, or deep — when the valves of the veins have failed or the vein has become obstructed.5
2014 SVS/AVF venous leg ulcer guidelines recommend comprehensive venous duplex ultrasound examination of the lower extremity in all patients with a suspected venous leg ulcer to identify the cause.6
|CHARACTERISTIC||ARTERIAL ULCER||VENOUS ULCER|
Ulcer appearance together with the medical history and physical exam should be used to determine the different diagnosis and see if a venous leg ulcer is suspected.
Comprehensive Venous Duplex Ultrasound Examination of the lower extremity should be performed in all patients with a suspected venous leg ulcer in order to identify the cause. The Society of Vascular Surgery (SVS) and the American Venous Forum (AVF) 2014 venous leg ulcer guidelines provide a strong recommendation for conducting this exam.
Venous leg ulcers can be caused by chronic venous insufficiency (CVI)1, a more serious form of venous reflux disease which can cause reflux in any of the venous systems — superficial, perforatoror deep. Ultrasound testing will help define the underlying cause of this disease and help in determining the right treatment for patients.
Treating patients with venous ulcers is not easy. It is important to not only treat the wound but also identify the cause — enabling your patients to live without the discomfort of these wounds.
Patients with less than 40% wound closure at four weeks are unlikely to achieve complete wound healing and may benefit from alternative or advanced interventions.7
Due to pain, mobility limitations and other consequences, venous leg ulcers have been associated with increased rates of depression and substantial decreases in patient quality of life.11-13
Compared to compression therapy alone, minimally invasive treatments addressing the underlying cause of venous ulcers may:
The 2014 Society for Vascular Surgery (SVS) and the American Venous Forum (AVF) provide comprehensive guidelines on venous leg ulcers for clinical practices. Please refer to the guidelines below for further information regarding assessment and recommendations for venous leg ulcer management and treatment.6
|GRADE||DESCRIPTION OF RECOMMENDATION||METHODOLOGIC QUALITY OF SUPPORTING EVIDENCE|
Regarding the choice of method of saphenous ablation there are multiple RCTs showing strong and consistent evidence that modern open surgery radiofrequency and laser ablation are equivalent in effect and safety
Eberhardt, R., Raffetto, J. Chronic Venous Insufficiency. Circulation. 2005;111:2398-2409.
Venous Disease Coalition. “Chronic Venous Insufficiency | Venous Disease Coalition.” Venous Disease Coalition | Promoting Public Health Professional Awareness of Venous Disease. Venous Disease Coalition, 19 June 2010. Web. 09 Aug. 2011.
Chronic Venous Insufficiency.” Vascular Web. Society For Vascular Surgery, Jan. 2011. Web. 17 Aug. 2011. http://www.vascularweb.org/vascularhealth/Pages/chronic-venous-insufficiency.aspx.
Kanth, A., Khan, S., Gasparis, A., Labropoulos, N., et al. The Distribution and Extent of Reflux and Obstruction in Patients with Active Venous Ulceration. Phlebology. 2015; 30(5): 350-6.
Sufian, S., Lakhanpal, S., Marquez, J., et al. Superficial Vein Ablation for the Treatment of Primary Chronic Venous Ulcers. Phlebology. 2011; 26:301-6.
O’Donnell Jr, T.F., et al. Management of Venous Leg Ulcers: Clinical Practical Guidelines of the Society for Vascular Surgery and the American Venous Forum. J VascSurg. 2014; 60:3S-59S.
Howard M., et al. An Evidence-Based Algorithm for Treating Venous Leg Ulcers Utilizing the Cochrane Database of Systematic Reviews. WOUNDS. 2013; 25(9):242-250.
Rice, J. Burden of Venous Leg Ulcers in the United States. Journal of Medical Economics. 2014; 17(5): 347-356.
Internal data; Dymedex Study.
The Outpatient Wound Clinic Market: 2013 Report and Analytics. Net Health Analytics. 2010-2012 Claims Data.
Valencia I.C., Falabella A, Kirsner RS, et al. Chronic Venous Insufficiency and Venous Leg Ulceration. J Am Acad Dermatol. 2001; 44:401-21.
Phillips, T., Stanton, B., Provan, A., et al. A Study of the Impact of Leg Ulcers on Quality of Life: Financial, Social and Psychologic Implications. J Am Acad Dermatol. 1994; 31:49-53.
Green, J., Jester, R. Health-related Quality of Life and Chronic Venous Leg Ulceration: Part 1. Wound Care. 2009; December: S12-S17.
Harlander-Locke, et al. The Impact of Ablation of Incompetent Superficial and Perforator Veins on Ulcer Healing Rates. J Vasc Surg. 2012; 55:458-64.
Harlander-Locke, et al. Combined Treatment with Compression Therapy and Ablation of Incompetent Superficial and Perforating Veins Reduces Ulcer Recurrence in Patients with CEAP 5 Venous Disease. J Vasc Surg; 55:446-50 (2012).