Comparing the result of of iliac vein stenting and compression therapy in management of recurrent venous ulceration.
Venous ulceration is the most common etiology of lower extremity ulceration, approximately affecting almost 1% of the world's population. although its overall prevalence is relatively low, the refractory nature of venous ulceration increases morbidity, mortality , the patient's quality of life, and have a significant financial burden on the global budget. the primary risk factors are: old age, obesity deep venous thrombosis, phlebitis and previous leg injuries. Iliac vein compression is a prevalent finding in patients with venous system pathology. It has a variety of causes, including May-Turner syndrome, endometriosis, bladder distension, common iliac artery aneurysm or internal iliac artery aneurysm. venous compression becomes clinically significant when there's an increase in venous pressure, which in turn causes venous insufficiency. This contributes to the development of a state of chronic venous stasis, which sequentially causes pooling of blood, triggers further capillary damage and activates inflammatory mediators with the end result of venous ulcer development and impaired wound healing. Located on bony prominences, venous ulcers are typically shallow, irregular with granulation tissue and fibrin present in their bases. A careful physical examination is required for a proper diagnosis, but he clinical challenge remains in its management, which includes prevention or the treatment of the clinical implications. Treatment modalities should always be directed to the cause of the ulcer; they can be divided into: * non invasive management, such as medical therapy, bandaging and dressings. * invasive, such as endovascular and surgical techniques.
Study Type
OBSERVATIONAL
Enrollment
100
compression bandaging or graduated compression hosiery consists of applying a type of elastic device, mainly on the limbs, to exert a controlled pressure on the lower limbs. The controlled pressure exerted by medical compression stockings reduces the diameter of major veins, thereby increasing the velocity and volume of blood flow, along with conditions beneficial for the healing of chronic inflammatory disorders (e.g. cellulitis, erysipelas, venous leg ulcers, etc.), through reduced pro-inflammatory cytokine levels and higher levels of the anti-inflammatory cytokines.
using x-ray guidance (fluoroscopy) to place a an expandable metal mesh tube against the vein walls, acting as a scaffold to keep the veins open and improve blood flow
Faculty of Medicine
Asyut, Egypt
ulcer healing within 6 months
comparing the results of both modalities in recurrent venous ulcer healing
Time frame: baseline
patency on stents
primary assisted patency included those requiring reintervention to maintain patency; and secondary patency was defined as stents that were blocked and successfully reopened.
Time frame: baseline
compliance
to anticoagulation in case of stenting, or to elastic stocking in case of compression therapy, using methods that include patient self-reporting and clinical estimates
Time frame: baseline
assessment of venous disability score (VDS)
the VDS evaluates the effect of venous disease by quantifying the level of work based disability. It is scored on a scale of 0 to 3 (with 0 being the least severe and 3 the most severe), based on the ability to work an 8-hour day with or without provisions for external support.
Time frame: baseline
assessment of venous clinical severity score
the score is obtained by imaging vein segments with duplex Doppler or phlebography. It includes 9 hallmarks of venous disease, each scored on a severity scale from 0 to 3.
Time frame: baseline
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