Elsevier S & T

Venous Ulcers

Bergan, John J.; Shortell, Cynthia

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Table of contents

Table of Contentsv
Emblem of Hunczovksyxi
Contributorsxiii
Forewordxvii
Prefacexix
SECTION I: Etiology and Initial Evaluation of the Patient with Chronic Venous Insufficiency1
Chapter 1: Inflammation and the Pathophysiology of Chronic Venous Disease: Molecular Mechanisms3
INTRODUCTION3
LEUKOCYTE ACTIVATION AND MICROVASCULAR INFILTRATION4
INFLAMMATORY MEDIATORS5
TISSUE RESTRUCTURING6
PROTEOLYTIC DEGRADATION6
INFLAMMATION AS A REPAIR MECHANISM AND ITS RESOLUTION8
TRIGGER MECHANISMS FOR INFLAMMATION IN VENOUS DISEASE9
CONCLUSION AND SYNOPSIS11
ACKNOWLEDGMENT11
REFERENCES11
Chapter 2: Microcirculation in Chronic Venous Insufficiency15
HISTORICAL THEORIES15
ARTERIOVENOUS SHUNTING16
DIFFUSION BARRIER16
WHITE CELL TRAPPING18
LEUKOCYTES AND ENDOTHELIAL CELLS’ ACTIVATION19
CYTOKINES AND GROWTH FACTORS20
OXIDATIVE STRESS IN VENOUS ULCERS20
MMP AND VENOUS ULCER FORMATION21
THE ROLE OF FIBROBLASTS IN VENOUS ULCERS22
SUMMARY23
REFERENCES23
Chapter 3: Epidemiology of Venous Ulcers27
WHAT IS EPIDEMIOLOGY?27
WHAT IS THE DIFFERENCE BETWEEN INCIDENCE AND PREVALENCE?28
ETIOLOGIC SPECTRUM OF LEG ULCERS30
VENOUS ULCER PREVALENCE31
INCIDENCE OF VENOUS ULCERS34
AGE AND SEX DISTRIBUTION35
VENOUS ULCER HISTORY36
OBESITY37
HISTORY OF DEEP VEIN THROMBOSIS (DVT)37
HEALING AND SURVIVAL38
FUTURE TRENDS38
REFERENCES39
Chapter 4: Lower Extremity Ultrasound Evaluation and Mapping for Evaluation of Chronic Venous Diseas43
REQUIREMENTS AND SETTINGS43
SUPERFICIAL VEINS46
PERFORATING VEINS49
DEEP VEINS50
ULCER BED51
ULTRASOUND FINDINGS AND IMPLICATIONS FOR TREATMENT51
DU MAPPING FOR GUIDING TREATMENT52
REFERENCES52
Chapter 5: Hypercoagulable States Associated with Chronic Venous Insufficiency55
INTRODUCTION55
TREATMENT STRATEGIES62
SUMMARY63
REFERENCES64
Chapter 6: The Chronically Swollen Leg: Finding the Cause: Theory and Practice67
INTRODUCTION67
FLUID EXCHANGE IN THE MICROCIRCULATION68
MECHANISMS OF EDEMA69
CLINICAL PRESENTATION72
REFERENCES74
SECTION II: Nonoperative Management of Chronic Venous Insufficiency75
Chapter 7: Compression Therapy in Venous Leg Ulcers77
INTRODUCTION77
COMPRESSION DEVICES77
PREVENTION OF ULCER RECURRENCE86
COMPRESSION TECHNIQUES86
REFERENCES89
Chapter 8: Wound Healing: Adjuvant Therapy and Treatment Adherence91
MANAGEMENT OF VENOUS LEG ULCERS91
ADJUVANT THERAPIES93
TREATMENT ADHERENCE96
EMERGING COLLABORATIVE MODELS FOR VENOUS ULCER CARE99
CONCLUSION100
REFERENCES100
Chapter 9: Negative Pressure Dressings in Venous Ulcers105
CHRONIC WOUND FLUID106
LOCAL EDEMA106
LOCAL BLOOD FLOW107
BACTERIAL BURDEN107
WOUND BED DEFORMATION108
DIRECT WOUND CLOSURE108
WOUND HEALING ENVIRONMENT108
WOUND HYPOXIA109
ADJUNCT TO ASSISTED CLOSURE109
INDICATIONS AND CONTRAINDICATIONS110
CONCLUSION110
REFERENCES111
Chapter 10: Deep Vein Thrombosis and Prevention of Post-Thrombotic Syndrome113
INTRODUCTION113
RISK OF VENOUS THROMBOEMBOLISM, RECURRENCE, PTS, AND VENOUS ULCERS114
THROMBOPROPHYLAXIS: REDUCING THE INCIDENCE OF VTE AND LONG-TERM COMPLICATIONS116
REMAINING ISSUES IN THE PREVENTION OF POST-THROMBOTIC SYNDROME126
CONCLUSION127
DISCLOSURE/ACKNOWLEDGMENT127
CONFLICT OF INTEREST127
REFERENCES127
SECTION III: Theraputic Procedures for Chronic Venous Insufficiency133
Chapter 11: Results Comparing Compression Alone Versus Compression and Surgery in Treating Venous Ul135
INTRODUCTION135
THE ESCHAR VENOUS ULCER STUDY136
RESULTS FROM OTHER STUDIES145
CONCLUSIONS145
REFERENCES146
Chapter 12: Superficial Surgery and Perforator Interruption in the Treatment of Venous Leg Ulcers149
INTRODUCTION149
PRESENTATION OF PATIENTS WITH CVI149
DIAGNOSTIC TESTING FOR PATIENTS WITH VENOUS LEG ULCERS150
CONVENTIONAL SURGICAL PROCEDURES FOR CORRECTION OF CVI IN PATIENTS WITH VLU157
CONCLUSION169
REFERENCES170
Chapter 13: Endovascular Techniques for Superficial Vein Ablation in Treatment of Venous Ulcers173
HISTORICAL BACKGROUND174
ENDOVASCULAR OPTIONS175
MECHANISM OF ACTION175
PATIENT SELECTION177
OBLITERATIVE TECHNIQUES178
OUTCOMES180
COMPLICATIONS181
DISCUSSION182
REFERENCES183
Chapter 14: Treatment of Chronic Venous Insufficiency with Foam Sclerotherapy185
SUMMARY185
INTRODUCTION186
FOAM AND SCLEROSING FOAM187
CLINICAL APPLICATIONS OF FOAM SCLEROSANTS192
PHILOSOPHICAL CONCLUSIONS195
REFERENCES196
Chapter 15: Foam Treatment of Venous Leg Ulcers: The Initial Experience199
INTRODUCTION199
TREATMENT OPTIONS200
FROM CLASSIC SCLEROTHERAPY TO MICROFOAM SCLEROTHERAPY201
TECHNIQUE OF MICROFOAM SCLEROTHERAPY202
RESULTS203
SPECIFIC CHARACTERISTICS OF MICROFOAM207
SAFETY OF MICROFOAM208
COMMENTS209
REFERENCES211
Chapter 16: Foam Treatment of Venous Leg Ulcers: A Continuing Experience215
METHODS216
STATISTICAL ANALYSIS218
RESULTS218
DISCUSSION221
CONCLUSIONS223
REFERENCES224
Chapter 17: Ultrasound Guidance for Endovenous Treatment227
INTRODUCTION227
PREOPERATIVE ASSESSMENT227
EQUIPMENT228
VENOUS TESTING AND MAPPING228
ULTRASOUND MONITORING DURING ENDOVENOUS THERAPY231
ULTRASOUND MONITORING DURING SCLEROFOAM TREATMENT234
DISCUSSION239
CONCLUSIONS239
REFERENCES239
Chapter 18: Repair of Venous Valves in Severe Chronic Venous Insufficiency243
INTRODUCTION243
RATIONALE FOR REPAIR OF DEEP VENOUS VALVES244
METHODS244
RESULTS249
INDICATIONS254
CONCLUSIONS255
REFERENCES256
SECTION IV: Special Topics259
Chapter 19: Treatment of Recalcitrant Venous Ulcers with Free Tissue Transfer for Limb Salvage261
INTRODUCTION261
PATIENT EVALUATION AND SELECTION262
FLAP SELECTION266
SURGICAL TECHNIQUE268
POSTOPERATIVE CARE269
DISCUSSION269
CONCLUSIONS271
REFERENCES272
Chapter 20: The Diagnosis and Treatment of Major Venous Obstruction in Chronic Venous Insufficiency275
INTRODUCTION275
DIAGNOSIS AND EVALUATION277
ENDOVENOUS THERAPY281
SUMMARY295
REFERENCES295
Chapter 21: The Venous Ulcer and Arterial Insufficiency299
INTRODUCTION299
EVALUATION299
TREATMENT302
REVIEW OF CLINICAL STUDIES303
CONCLUSIONS305
REFERENCES305
Chapter 22: Topical Negative Pressure Techniques in Chronic Leg Ulcers307
INTRODUCTION307
HOW TO USE VAC THERAPY308
VAC THERAPY IN CHRONIC LEG ULCERS: A RANDOMIZED CLINICAL TRIAL308
VAC THERAPY IN CHRONIC LEG ULCERS: MODES OF ACTION321
LIMITATIONS OF VAC THERAPY321
CONCLUSIONS322
REFERENCES324
Epilogue327
REFERENCES328
Index329

Book details

Vendor Elsevier S & T
SKU 9780123735652
ISBN-13 9780080549033
Author Bergan, John J.; Shortell, Cynthia
Category Medical
Subject Pathophysiology

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One of the only books discussing new advances in venous ulcer therapy, Venous Ulcers provides a comprehensive look at the molecular biology and pathophysiology of venous ulcers. It discusses the many new treatments currently being used that offer non-invasive treatment options to patients with venous ulcerations.

* Leg ulcers are defined as a discontinuity of the epithelial surface; a local defect or excavation of the surface of the skin.
* Venous ulceration tends to take a number of months to heal followed by frequent relapse to further episodes.
* This work discusses the newest tools of patient investigation that have emerged in recent years that help to shorten patient recovery times and provide less invasive treatments

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