| 1. |
- Forssgren, Alexandra, et al.
(författare)
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A Repeat Validated Population Questionnaire of a Defined Swedish Population Verifies Reduction in Leg Ulcer Prevalence Over Time
- 2015
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Ingår i: Acta Dermato-Venereologica. - : Medical Journals Sweden AB. - 0001-5555 .- 1651-2057. ; 95:6, s. 725-729
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Tidskriftsartikel (refereegranskat)abstract
- This study was performed to measure if the introduced interventions in leg ulcer care in a selected Swedish county yield a detectable reduction in leg ulcer prevalence in the population. A validated postal questionnaire sent to 10,000 (9,868) randomly selected 30-89-year-olds in the Skaraborg county (255,042 inhabitants). All positive responders were telephone-interviewed and verified ulcer patients were clinically examined including assessment of arterial/venous circulation with hand-held Doppler and, where indicated, duplex ultrasound scanning. All results were compared with numbers from 1990 (initial study). The response rate was 82% (8,070/9,868), 200 active ulcers and 290 previous ulcers. The calculated prevalence was 0.75% for 30-89 years and 1.05% for 50-89 years (2.1% in 1990). The leg ulcer prevalence was reduced by 32% (0.52% compared to 0.77% in 1990), and the relative risk was reduced by 50% (95% CI 0.36-0.69). The study shows a true reduction in leg ulcer prevalence detectable in the population supporting a successful care of leg ulcer patients.
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| 2. |
- Forssgren, A., et al.
(författare)
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Changes in the aetiological spectrum of leg ulcers after a broad-scale intervention in a defined geographical population in Sweden
- 2012
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Ingår i: European Journal of Vascular and Endovascular Surgery. - : Elsevier BV. - 1078-5884 .- 1532-2165. ; 44:5, s. 498-503
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The study aims to compare the spectrum of leg ulcer aetiology in Skaraborg County in 1988 and 2002, an evaluation of 14 years of targeted leg ulcer intervention. Design: Cross-sectional study within the professional health-care system in Skaraborg County. Materials: In 2002, 621 leg ulcer patients were identified through a cross-sectional population survey. Methods: Half of the registered patients were randomly selected and offered clinical examination. A total of 198 patients with 246 legs underwent examination and were categorised in detail according to aetiology. Data were compared with the initial study in 1988. Results: Venous incompetence was present in 140 (57%) legs and the dominating cause in 94 (38%) of the leg ulcers, 40 (16%) due to deep venous incompetence. Arterial insufficiency was identified in 90 (37%) legs and the dominating aetiological factor in 41 legs (17%), eight (3%) being critical ischaemic ulcers. The relative risk (RR) of developing a leg ulcer in 2002 vs. 1988 was 0.77. The RR of a venous ulcer was reduced by 46%, arterial by 28%, while there was an increase in diabetic ulcers by 29% and multifactorial by 42%. Conclusion: The aetiological spectrum of leg ulcers has changed, most likely due to a new management strategy in the care of leg ulcer patients.
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| 3. |
- Forssgren, Alexandra, et al.
(författare)
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Leg ulcer point prevalence can be decreased by broad-scale intervention : a follow-up cross-sectional study of a defined geographical population
- 2008
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Ingår i: Acta Dermato-Venereologica. - 0001-5555 .- 1651-2057. ; 88:3, s. 252-6
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Tidskriftsartikel (refereegranskat)abstract
- In 1988 a cross-sectional epidemiological study was performed in Skaraborg County, Sweden, establishing leg ulcer point prevalence. Based on the results of that study a complete change in the care of leg ulcer patients was brought into practice. The objective of this postal cross-sectional follow-up study was to evaluate the success of the new management strategy. Responding healthcare providers were asked to report all patients with an open wound below the knee that did not heal within a 6-week period after onset of ulceration. Validity of results was ensured by examining 203 randomly selected patients. Based on clinical examination, an assessment of the underlying causes of ulceration was made. The study setting was inpatient and outpatient care in hospitals, primary care and community care within Skaraborg, with a population of 254,111. The response rate was 100% from district nurses, hospital wards and outpatient clinics. Reports were collected from healthcare providers, mainly nurses, in all 15 communities. A total of 621 individual patients with active leg ulcers were identified. Age-adjusted sex ratio of ulcer patients was 1:1.1 (M:F). The median age was 79 years. A total of 507 patients (82%) were older than 64 years. District and community nurses provided care for the majority (88.5%) of patients. The study verified a point prevalence of 2.4/1000 population in 2002 compared with 3.1/1000 in 1988, a 23% decrease in leg ulcer prevalence. Venous insufficiency was still the dominating causative factor, although the number of patients with venous leg ulcers was reduced by 46%. Arterial ulcers had decreased by 23%, while patients with ulcers of diabetic and multifactorial causes were increased. In conclusion, it is likely that this reduction in point prevalence reflects the introduction of the change in management strategy undertaken in the area.
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| 4. |
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| 5. |
- Lee, Byung-Boong, et al.
(författare)
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Venous hemodynamic changes in lower limb venous disease : the UIP consensus according to scientific evidence
- 2016
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Ingår i: International Journal of Angiology. - : Springer. - 0392-9590 .- 1827-1839. ; 35:3, s. 236-352
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Tidskriftsartikel (refereegranskat)abstract
- There are excellent guidelines for clinicians to manage venous diseases but few reviews to assess their hemodynamic background. Hemodynamic concepts that evolved in the past have largely remained unchallenged in recent decades, perhaps due to their often complicated nature and in part due to emergence of new diagnostic techniques. Duplex ultrasound scanning and other imaging techniques which evolved in the latter part of the 20th century have dominated investigation. They have greatly improved our understanding of the anatomical patterns of venous reflux and obstruction. However, they do not provide the physiological basis for understanding the hemodynamics of flow, pressure, compliance and resistance. Hemodynamic investigations appear to provide a better correlation with post-treatment clinical outcome and quality of life than ultrasound findings. There is a far better prospect for understanding the complete picture of the patient's disability and response to management by combining ultrasound with hemodynamic studies. Accordingly, at the instigation of Dr Angelo Scuderi, the Union Internationale de Phlebologie (UIP) executive board commissioned a large number of experts to assess all aspects of management for venous disease by evidence-based principles. These included experts from various member societies including the European Venous Forum (EVF), American Venous Forum (AVF), American College of Phlebology (ACP) and Cardiovascular Disease Educational and Research Trust (CDERT). Their aim was to confirm or dispel long-held hemodynamic principles and to provide a comprehensive review of venous hemodynamic concepts underlying the pathophysiology of lower limb venous disorders, their usefulness for investigating patients and the relevant hemodynamic changes associated with various forms of treatment. Chapter 1 is devoted to basic hemodynamic concepts and normal venous physiology. Chapter 2 presents the mechanism and magnitude of hemodynamic changes in acute deep vein thrombosis indicating their pathophysiological and clinical significance. Chapter 3 describes the hemodynamic changes that occur in different classes of chronic venous disease and their relation to the anatomic extent of disease in the macrocirculation and microcirculation. The next four chapters (Chapters 4-7) describe the hemodynamic changes resulting from treatment by compression using different materials, intermittent compression devices, pharmacological agents and finally surgical or endovenous ablation. Chapter 8 discusses the unique hemodynamic features associated with alternative treatment techniques used by the CHIVA and ASVAL. Chapter 9 describes the hemodynamic effects following treatment to relieve pelvic reflux and obstruction. Finally, Chapter 10 demonstrates that contrary to general belief there is a moderate to good correlation between certain hemodynamic measurements and clinical severity of chronic venous disease. The authors believe that this document will be a timely asset to both clinicians and researchers alike. It is directed towards surgeons and physicians who are anxious to incorporate the conclusions of research into their daily practice. It is also directed to postgraduate trainees, vascular technologists and bioengineers, particularly to help them understand the hemodynamic background to pathophysiology, investigations and treatment of patients with venous disorders. Hopefully it will be a platform for those who would like to embark on new research in the field of venous disease.
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| 6. |
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| 7. |
- Nelzén, Olle
(författare)
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A medial approach for open redo groin surgery for varicose vein recurrence Safe and effective
- 2013
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Ingår i: Phlebologie (Stuttgart). - : Georg Thieme Verlag KG. - 0939-978X .- 2567-5826. ; 42:5, s. 247-252
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Tidskriftsartikel (refereegranskat)abstract
- Aims: To describe the technique of a medial approach for redo groin surgery for varicose vein recurrence and to report the one year prospective results for this procedure. Method: The standardised technique employed is described. Prospective one year data regarding the effectiveness of this procedure was taken from a one year audit performed 2009-2010 at Skaraborg Hospital. Details regarding this patient cohort and the surgery performed were registered. The outcome was measured by using venous clinical severity score (VCSS) and the disease specific quality of life was measured with the Aberdeen varicose vein questionnaire (AVVQ). Venous duplex ultrasound scanning (DUS) was performed preoperatively, after 4-6 weeks and after one year. Results: Out of 255 venous operations 34 regarded redo groin surgery and these were assessed. Females dominated 25/34 and the median age was 55 years (range 26-80). All patients had a probable stump according to DUS. CEAP C3-C4 dominated 28 patients/legs and C5-C6 in 4 legs. The median operating time was 69 minutes (range 35-120) and the operating time was significantly correlated to the number of incisions (p<0.001). The complication rate was 15%, including 2 wound infections but no DVT or lymph leakage. Both the VCSS and the AVVQ scores were significantly improved after one year (p<0.001). After one year DUS detected recurrence in the groin was observed in 19%, mostly neovascularisation. Conclusion: Redo groin surgery by a standardised medial approach is a safe and not an especially technically demanding technique that can be performed reasonably rapidly. The one year results are promising and the early DUS recurrence rate seems low.
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| 8. |
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| 9. |
- Nelzén, Olle, et al.
(författare)
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Early results from a randomized trial of saphenous surgery with or without subfascial endoscopic perforator surgery in patients with a venous ulcer
- 2011
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Ingår i: British Journal of Surgery. - : Oxford University Press (OUP). - 0007-1323 .- 1365-2168. ; 98:4, s. 495-500
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The aim was to clarify the role of incompetent perforators (IPs) in venous leg ulcers. This short-term report focused on safety, patient satisfaction and the fate of IPs after subfascial endoscopic perforator surgery (SEPS), or saphenous surgery alone. METHODS: Patients aged 30-78 years with an open or recently healed venous ulcer, and with an incompetent saphenous vein and IPs, were allocated randomly to saphenous surgery alone, or in combination with SEPS. A control duplex scan was performed 6-9 months after surgery, and clinical follow-up was scheduled after 1 week, 3 and 12 months. A standard questionnaire was completed at each clinical visit. RESULTS: Seventy-five patients were enrolled; 37 had SEPS and 38 had saphenous surgery alone. SEPS prolonged the operation by a median of 15 min (P = 0.003). Duplex imaging revealed significantly more remaining IPs in the no-SEPS group (P < 0.001). Compared with the preoperative scan, significantly more legs were free from IPs in the SEPS group compared with the no-SEPS group (21 of 36 versus 7 of 37 respectively; P < 0.001). There were no other major outcome differences between the groups. CONCLUSION: There was no short-term clinical benefit from adding SEPS to saphenous surgery in patients with varicose ulcers and IPs, although SEPS reduced the number of perforators remaining after 1 year.
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