{"title":"The calf vein thrombosis","authors":"Pier Luigi Antignani , Leonardo Aluigi","doi":"10.1016/j.rvm.2012.07.001","DOIUrl":"10.1016/j.rvm.2012.07.001","url":null,"abstract":"<div><p>The distal vein thrombosis<span><span> is a special disease poorly studied and actually without consensus on the diagnostic evaluation and on the necessary treatment. Sometimes this disease has a good prognosis, but it can extend to proximal veins and it can progress to </span>pulmonary embolism<span><span>, especially in its bilateral presentation. The main diagnostic test is color duplex Doppler evaluation with compression test, mostly if in expert hands. Compression ultrasound sonography<span> (CUS) has sensibility ranging between 88% and 95% compared to phlebography. Serial ultrasound has two objectives: the first is the diagnosis of distal thrombosis, the second is the evaluation of thrombosis progression to proximal vein. The natural history of this disease is poorly documented and there is no consensus on the necessity of screening and treating patients presented with isolated distal DVT. Some authors use </span></span>oral anticoagulants; others prefer serial echo-color-Doppler before starting therapy. Recent clinical evidences suggest the use of low weight heparin.</span></span></p></div>","PeriodicalId":101091,"journal":{"name":"Reviews in Vascular Medicine","volume":"1 1","pages":"Pages 1-4"},"PeriodicalIF":0.0,"publicationDate":"2013-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rvm.2012.07.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81400767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jürg Hafner , Stephan Nobbe , Severin Läuchli , Katrin Kerl , Lars E. French , Nedzimin Pelivani , Kornelia Böhler , Dieter Mayer , Patricia Senet
{"title":"Martorell hypertensive ischemic leg ulcer must not be confounded with pyoderma gangrenosum: Management is totally different","authors":"Jürg Hafner , Stephan Nobbe , Severin Läuchli , Katrin Kerl , Lars E. French , Nedzimin Pelivani , Kornelia Böhler , Dieter Mayer , Patricia Senet","doi":"10.1016/j.rvm.2012.08.001","DOIUrl":"10.1016/j.rvm.2012.08.001","url":null,"abstract":"<div><h3>Introduction</h3><p><span>Martorell hypertensive ischemic leg ulcer (HYTILU) and </span>pyoderma gangrenosum share a violaceous, rapidly progressive necrotic wound border and excruciating pain as essential clinical features. Clinicians unaware of Martorell HYTILU readily misdiagnose pyoderma gangrenosum or necrotic vasculitis. This can be detrimental since disease management is totally different.</p></div><div><h3>Material and methods</h3><p><span>This review includes two patient series with Martorell hypertensive ischemic leg ulcer (HYTILU), 31 patients from the University Hospital of Zurich and 64 patients from a </span>randomized controlled trial in France. The analysis of confounding Martorell HYTILU and histological study is based on the Zurich data and the analysis of therapeutic issues is based on the French and Zurich data.</p></div><div><h3>Results</h3><p><span><span>Fifty-two percent (16/31 patients) were referred with an erroneous diagnosis of pyoderma gangrenosum, and another 19% (6/31 patients) with an erroneous diagnosis of necrotizing vasculitis. The hallmark of Martorell HYTILU are the location at the laterodorsal leg or </span>Achilles tendon (in the present series 100%) in a patient with usually long-standing and controlled hypertension (95–100%), often accompanied by diabetes (40–60%). Histology of a several centimeter long, 4–6</span> <span><span>mm narrow, and deep (to fascia) performed spindle-shape skin and ulcer biopsy shows a skin infarction with sclerotic subcutaneous arterioles. </span>Arteriolosclerosis<span> is defined by thick vessel walls at the cost of a narrow lumen, and in approximately 70% of histologic sections part of the arterioles show a striking medial calcification. The narrow lumen may be occluded by acute or organized thrombosis. In the French multicenter serie, at 8 weeks only 10% (3/31 patients) healed by conservative means, and this could not be improved with the use of topical application<span> of platelet-derived growth factor-BB (becaplermin) (18% healing, 5/28 patients, no significant difference). In the Zurich series, 84% of patients (26/31) had wound surgery (necrosectomy, split skin graft) to heal the ulcer and 10% (3/31) died from wound infection and sepsis, amongst two under immunosuppression received for misdiagnosed pyoderma gangrenosum.</span></span></span></p></div><div><h3>Conclusions</h3><p>Martorell HYTILU can easily be confounded with pyoderma gangrenosum or necrotizing vasculitis. Physicians involved in wound treatment should be sensitized to the typical clinical setting: a progressive and extremely painful skin infarction at the laterodorsal leg in a hypertensive and often diabetic subject. Diagnosis is confirmed histologically on a long-enough, narrow, but deep spindle-shape skin and ulcer biopsy, showing a highly characteristic form of stenotic and occlusive subcutaneous arteriolosclerosis. Management is essentially based on wound surgery. Conservative means are almost un","PeriodicalId":101091,"journal":{"name":"Reviews in Vascular Medicine","volume":"1 1","pages":"Pages 5-8"},"PeriodicalIF":0.0,"publicationDate":"2013-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rvm.2012.08.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87445710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Compression therapy in leg ulcers","authors":"Hugo Partsch","doi":"10.1016/j.rvm.2013.02.001","DOIUrl":"10.1016/j.rvm.2013.02.001","url":null,"abstract":"<div><p><span><span>The purpose of this article is to give a review on different compression modalities for the management of leg ulcers and to evaluate their efficacy based on evidence coming from </span>clinical trials and experimental studies. Interface pressure-peaks on the leg during walking exceeding 50–60</span> <span>mmHg reduce venous reflux<span><span> and increase venous pumping function. This may be achieved by stiff compression textiles like multicomponent bandages especially when containing cohesive material or by zinc paste bandages. These compression types exert high stiffness which is characterized by a tolerable resting pressure and high pressure peaks during walking (“working pressure”), but need to be applied by well trained and experienced staff. Short-stretch adjustable Velcro-wraps and (double) compression stockings may be promising alternatives allowing self-management. </span>In patients<span> with arterial occlusive disease (ABPI 0,6–0,8) modified compression using stiff material applied with reduced pressure (<40</span></span></span> <span>mmHg) under careful control may increase both, arterial flow and venous pumping function.</span></p></div><div><h3>Conclusion</h3><p>In addition to the principles of modern wound management and to endovenous procedures abolishing superficial venous reflux compression therapy<span> in combination with mobilization and walking exercises is still the basic treatment modality of leg ulcers.</span></p></div>","PeriodicalId":101091,"journal":{"name":"Reviews in Vascular Medicine","volume":"1 1","pages":"Pages 9-14"},"PeriodicalIF":0.0,"publicationDate":"2013-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rvm.2013.02.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72851415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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