Comparative effectiveness of surgical interventions aimed at treating underlying venous pathology in patients with chronic venous ulcer

Malas MB, Quasi U, Lazarus G, et al. J Vasc Surg: Venous Lymphat Disord. 2014;2:212-25. This review was contracted by the US Agency for Health Care Research and Quality (AHRQ) for the Johns Hopkins Evidence-based Practice Center. Two key questions were developed: 1. For patients with a chronic venous ulcer (CVU), what are the benefits and harms of surgical procedures? 2. For patients with a CVU, what are the comparative benefits and harms of different surgical procedures for a given type of venous reflux and obstruction? A systematic review was conducted and 10 646 citations were identified, of which, 22…

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Skin necrosis as a complication of compression in the treatment of venous disease and in prevention of venous thromboembolism

Michel PERRIN Vascular Surgeon, Chassieu, France BACKGROUND The main concern with compression treatment for chronic venous disease of the lower limb remains compliance, which is difficult to assess depending on the clinical status. Complications like skin allergic reaction and eczema,1 and nerve palsy,2 have been reported, but the most severe is skin necrosis in diabetics or patients with peripheral arterial disease of the lower limbs. There is a consensus for contraindicating compression in patients whose ankle/brachial index (ABI) is less than 0.6, but the arterial disease is not always identified. Diabetes also carries a potential risk of skin wound, but…

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