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Varicose Ulcer (Ulcer, Venous)

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Skin breakdown or ulceration caused by varicose veins in which there is too much hydrostatic pressure in the superficial venous system of the leg. Venous hypertension leads to increased pressure in the capillary bed, transudation of fluid and proteins into the interstitial space, altering blood flow and supply of nutrients to the skin and subcutaneous tissues, and eventual ulceration.

Also Known As:

Ulcer, Venous; Venous Ulcer; Venous Hypertension Ulcers; Venous Stasis Ulcers; Hypertension Ulcer, Venous; Hypertension Ulcers, Venous; Stasis Ulcer, Venous; Stasis Ulcers; Stasis Ulcers, Venous; Ulcer, Stasis; Ulcer, Varicose; Ulcer, Venous Hypertension; Ulcer, Venous Stasis; Ulcers, Stasis; Ulcers, Varicose; Ulcers, Venous; Ulcers, Venous Hypertension; Ulcers, Venous Stasis; Varicose Ulcers; Venous Hypertension Ulcer; Venous Stasis Ulcer; Venous Ulcers; Stasis Ulcer

Networked: 637 relevant articles (70 outcomes, 135 trials/studies)

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Disease Context: Research Results

Related Diseases

1.	Ulcer
2.	Wounds and Injuries (Trauma)
3.	Pressure Ulcer (Bedsore)
4.	Infection
5.	Edema

Experts

1.	Nelson, E Andrea: 10 articles (03/2014 - 01/2007)
2.	Cesarone, M R: 9 articles (09/2011 - 12/2001)
3.	Belcaro, G: 9 articles (09/2011 - 12/2001)
4.	Falanga, Vincent: 7 articles (03/2015 - 08/2002)
5.	O'Meara, Susan: 7 articles (01/2015 - 01/2009)
6.	Buffone, Gianluca: 6 articles (12/2015 - 02/2012)
7.	Serra, Raffaele: 6 articles (12/2015 - 02/2012)
8.	de Franciscis, Stefano: 6 articles (12/2015 - 02/2012)
9.	Brem, Harold: 6 articles (09/2014 - 07/2004)
10.	Tomic-Canic, Marjana: 6 articles (09/2014 - 01/2007)

Drugs and Biologics

Drugs and Important Biological Agents (IBA) related to Varicose Ulcer:

1.	Pentoxifylline (Trental)FDA LinkGeneric 01/01/2012 - "Pentoxifylline is an effective adjunct to compression bandaging for treating venous ulcers and may be effective in the absence of compression. " 01/01/2007 - "Pentoxifylline is an effective adjunct to compression bandaging for treating venous ulcers and may be effective in the absence of compression. " 01/01/2002 - "Pentoxifylline appears to be an effective adjunct to compression bandaging for treating venous ulcers. " 01/01/2000 - "Pentoxifylline in the absence of compression may be effective for treating venous ulcers in the absence of compression, although the evidence should be cautiously interpreted. " 01/01/2000 - "Pentoxifylline appears to be an effective adjunct to compression bandaging for treating venous ulcers. "
2.	cadexomer iodineIBA 07/01/1983 - "A randomized trial comparing cadexomer iodine and standard treatment in the out-patient management of chronic venous ulcers." 09/28/1985 - "Controlled trial of Iodosorb in chronic venous ulcers." 08/31/1985 - "Controlled trial of Iodosorb in chronic venous ulcers." 08/03/1985 - "Controlled trial of Iodosorb in chronic venous ulcers." 07/01/1989 - "Multicenter trial of cadexomer iodine to treat venous stasis ulcer."
3.	OxygenIBA 01/01/2001 - "The purpose of this study was to compare the partial pressure of transcutaneous tissue oxygen (TcPO2) in persons with venous ulcers in four positions with and without inspired oxygen. " 07/01/1987 - "This study supports the existence of a local pathologic barrier to oxygen diffusion in patients with venous ulcers." 02/01/2012 - "We applied the matrix in 15 patients with chronic venous ulcers, and evaluated the transcutaneous oxygen tension (TcPO(2)) and vascular density. " 09/01/2009 - "This pilot study suggests that VAC therapy does not change oxygen partial pressure around venous ulcers. " 01/01/2001 - "Capillary density and transcutaneous oxygen partial pressure were of prognostic impact as to healing of venous ulcers."
4.	CollagenIBA 02/01/2012 - "Our results have shown the efficacy of bone marrow-impregnated collagen matrix for the treatment of intractable venous ulcers." 02/01/2012 - "This study was designed with the aim of clinically evaluating the effects of bone marrow-impregnated collagen matrix on wound healing of venous ulcers. " 09/01/1999 - "A 25 patient study was conducted into the relationship between markers of collagen metabolism in venous ulcer exudates and healing status, and their prognostic value in predicting healing performance. " 04/01/1995 - "The combined results of the two trials suggest that, at doses of 0.5 to 2.5 microg/cm(2), bovine transforming growth factor-beta(2) is safe as a topically applied agent in a collagen matrix vehicle and can have a positive effect on closure of venous stasis ulcers. " 04/01/1995 - "Two clinical trials were conducted to evaluate the safety and effect of transforming growth factor-beta(2) purified from bovine bone and delivered topically to venous stasis ulcers three times per week for up to 6 weeks by means of a lyophilized collagen vehicle. "
5.	SilverIBA 06/01/2010 - "In subjects with venous ulcers: After 4 weeks, the silver treatment was more effective than the control group treatment: Skin PO2 was increased 2.1 times more than the control group (17.4% to 8.2%) and skin flux (RF) was improved 1.6 times more than the control group (-38.7% to -24.2%). " 01/01/2009 - "The aim of this work was to study the safety and effectiveness of silver foam dressing (Contreet® Ag, Coloplast, Humlebaek, Denmark) in promoting the healing of infected venous ulcers over 9 weeks of treatment. " 02/01/2003 - "Clinical experience using silver antimicrobial dressings on venous stasis ulcers." 05/01/1946 - "Treatment of varicose ulcers with silver-coated adhesive tape." 07/01/2007 - "Silver-impregnated vacuum-assisted closure in the treatment of recalcitrant venous stasis ulcers."
6.	Diosmin (Daflon)IBA 01/01/1997 - "The objective of this study was to evaluate the efficacy of Daflon 500 mg (Dios)* in venous ulcers. " 09/01/2005 - "These results confirm that venous ulcer healing is accelerated by Daflon 500 mg treatment. " 05/01/2003 - "Ten patients with a healed venous ulcer were treated with flavonoid substance (90% diosmin), 1000 mg three times daily for 30 days. " 09/01/2005 - "In randomized trials, 60 days of therapy with Daflon at a dosage of 500 mg 2 tablets daily was effective, in addition to elastic compression, in accelerating venous ulcer healing. " 01/01/1997 - "This study showed that a two-month course of Daflon 500 mg at a daily dose of two tablets, in addition to conventional treatment, is of benefit in patients with venous ulcer < or = 10 cm by accelerating complete healing."
7.	Hyaluronic Acid (Hyaluronan)IBA 10/01/2003 - "The hyaluronan derivative showed promising results in initiating the healing process in chronic venous ulcers. " 11/15/1978 - "[Use of hyaluronic acid in the therapy of varicose ulcers of the lower limbs]." 10/01/2013 - "The combination of collagenase and hyaluronic acid is safe and effective for chronic venous ulcers." 10/01/2013 - "We evaluated the performance and tolerability of a new composite ointment containing collagenase and hyaluronic acid for chronic venous ulcers. " 10/01/2013 - "Multicenter clinical trial on the performance and tolerability of the Hyaluronic acid-collagenase ointment for the treatment of chronic venous ulcers: a preliminary pilot study."
8.	Urokinase-Type Plasminogen Activator (Urokinase)FDA Link 08/01/2000 - "These findings suggest that regulation of protease activity by u-PA and PAI-2 may play a role in the impaired healing of chronic venous ulcers." 06/01/1995 - "Bioimmunoassays for tissue and urokinase-type plasminogen activators (t-pA and u-pA), and enzyme-linked immunosorbent assays (ELISA) for t-pA were performed on biopsies from the edge and base of 15 venous ulcers. " 06/01/1995 - "Venous ulcer bases contain significantly greater quantities of u-pA, TGF-beta 1, and bFGF than ulcer edges. " 12/01/2004 - "Epithelial tissue-type plasminogen activator expression, unlike that of urokinase, its receptor, and plasminogen activator inhibitor-1, is increased in chronic venous ulcers." 06/01/1995 - "Growth factors, tissue and urokinase-type plasminogen activators in venous ulcers."
9.	Intercellular Signaling Peptides and Proteins (Growth Factors)IBA 07/01/2004 - "Further clinical studies are needed to elucidate the role growth factors may play in venous ulcers." 10/01/1989 - "A short-term clinical study on the effect of purified angiogenic and growth factors from human term placenta in the treatment of chronic varicose ulcers was carried out in 18 patients. " 02/01/2009 - "A variety of dressings, growth factors, and adjunct therapies are used to treat venous ulcers, but none seems to yield satisfactory results. " 08/01/2008 - "Altering the p38 pathway in vivo with growth factors or cytokine inhibition may improve fibroblast proliferation and venous ulcer healing." 01/01/2000 - "Current data imply there is no deficiency but rather an unfavorable distribution of growth factors in venous ulcers. "
10.	alginic acid (sodium alginate)IBA 01/01/2015 - "Published or unpublished randomised controlled trials (RCTs) that evaluated the effects of any type of alginate dressing in the treatment of venous ulcers were included. " 01/01/2013 - "Published or unpublished randomised controlled trials (RCTs) that evaluated the effects of any type of alginate dressing in the treatment of venous ulcers were included. " 02/01/2008 - "This community-based open-label randomized trial allocated people with a venous ulcer to calcium alginate dressings impregnated with manuka honey or usual care. " 09/01/2003 - "Dressings were changed weekly and patients were followed for a maximum of 6 weeks or until the venous ulcer no longer required the use of an alginate dressing. " 09/01/2003 - "Evaluation of two calcium alginate dressings in the management of venous ulcers."

Therapies and Procedures

1.	Compression Bandages 01/01/2002 - "There was no significant improvement in venous ulcer healing using higher compression elastic bandages." 03/01/1993 - "Our results uphold the commonly held clinical opinion that only compression bandages or strong stockings are effective in the treatment of venous ulcers. " 12/01/1999 - "The studies reviewed provide reasonable evidence that venous ulcers can be healed with the use of compression wraps and that various wraps are effective when used with correct assessment, application, and fit by the caregiver, along with compliance and mobility of the patient." 08/01/2015 - "A study of the Unna Boot compared with the elastic bandage in venous ulcers: a randomized clinical trial." 01/01/2014 - "Randomised controlled trials (RCTs)evaluating compression bandages or hosiery for preventing the recurrence of venous ulcers. "
2.	Bandages (Bandage) 03/01/1999 - "The use of a noncontact radiant heat bandage is a safe and efficacious inpatient therapy for the management of chronic venous stasis ulcers in patients who have failed conventional therapy." 08/01/2013 - "Each patient with a venous ulcer received compression therapy with a short stretch bandage system and either a BWD + foam (study group [SG]) or foam (control group [CG]). " 01/01/2013 - "The sample consisted of 32 patients with venous ulcers who underwent treatment with the Unna boot and 11 patients (control group), who used a simple bandage application. " 04/01/2007 - "The SCD EXPRESS Compression System accelerates venous flow in the legs of patients with venous ulcers already treated with a four-layer bandage. " 04/01/2007 - "To test the hypothesis that the SCD EXPRESS intermittent pneumatic compression applied in combination with a four-layer bandage in patients with venous ulcers increases popliteal vein volume flow and velocity. "
3.	Transplants (Transplant) 10/01/1990 - "This prospective comparison of the 2 surgical treatments (PLSVS versus PLSVS and correction of deep venous valve) demonstrated that disassociation of the superficial from the deep venous system with PLSVS and correction of the deep valve (valvuloplasty, transposition or valve transplant) produced promising results in the treatment of recurrent venous ulcer. " 12/01/2011 - "The averages of these data were calculated and compared with results of other studies in the literature, the nerve grafts for defects and the Socket joints for venous ulcers. " 05/01/2011 - "A systematic review of the literature on the use of amniotic membrane grafts for the treatment of venous ulcers was performed up to 2010. " 10/06/2010 - "Compression therapy, surgical ablation of superficial venous reflux, and tangential ablation with split skin graft (shave treatment) of refractory venous ulcers are the mainstays in the treatment of CVI." 01/01/2010 - "Average treatment costs for venous ulcers amounted to EUR 5,357, compared to EUR 5,722-8,622 reimbursed according to the German DRG system (2010) for an in-patient skin graft. "
4.	Debridement 12/01/2012 - "The objective of this study was to correlate the pathologic findings in venous ulcers with wound healing to establish a negative margin for debridement. " 09/01/2009 - "This study describes the impact of 80% adherence to guideline concordant care for compression therapy, moist wound-healing environment, and debridement on venous ulcer outcomes. " 07/01/2000 - "The study confirms both the clinical efficacy and cost effectiveness of larval therapy in the debridement of sloughy venous ulcers." 12/01/2012 - "Of the 26 patients who met inclusion criteria, only 50% of them (13 patients) with a total of 18 venous ulcers underwent surgical debridement available for pathologic analysis. " 12/01/2012 - "Pathologic analysis of deep tissue obtained during debridement of venous ulcers is often unnoticed in its importance. "
5.	Compression Stockings 05/01/1988 - "Calf pump function in patients with healed venous ulcers is not improved by surgery to the communicating veins or by elastic stockings." 08/01/2014 - "The aim of this study was to determine the rate of venous ulcer recurrence and the level of compliance in patients wearing European class 1 or class 2 compression stockings. " 07/01/2010 - "Ease of application of medical compression-stocking systems for the treatment of venous ulcers." 02/01/2010 - "Comparison of low-strength compression stockings with bandages for the treatment of recalcitrant venous ulcers." 05/01/2003 - "Interface pressure under a ready made compression stocking developed for the treatment of venous ulcers over a period of six weeks."