ABC OF VENOUS ULCERS HENDOLAT VEINS Dr Gerardo Peón Peralta .- Especialista en Angiología y Cirugía Vascular.

1. ABC OF VENOUS ULCERS
FROM WORK-UP TO HEALING
Gerardo Peón Peralta MD
VASCULAR SURGERY

2. CLINICAL CLASSIFICATION

3. CLINICAL CLASSIFICATION

4. ETIOLOGY
INTRAVENOUS EXTRAVENOUS
SECUNDARY
PRIMARY

5. ANATOMY

6. PATOPHYSIOLOGY
OBSTRUCTION REFLUX

7. 3 POINTS OF CARE
VEIN CARE WOUND CARE

8. 3 POINTS OF CARE
AND MEDICAL TREATMENT
COMPRESSION
PHARMACOLOGICAL

9. WORK-UP
• DOPPLER ULTRASOUND

10. WORK-UP
• DOPPLER ULTRASOUND

11. WORK-UP
• DOPPLER ULTRASOUND

12. WORK-UP
• VENOGRAM

13. WORK-UP
• VENOUS CT

14. WORK-UP ALGORITM
REFLUX / OBSTRUCTION
IN DOPPLER US
ADDITIONAL IMAGING IF NEEDED
Reflux dominates Obstruction dominates
EVLA / RFA / ScleroTx
Stripping
Angioplasty / Stent
Follow - Up

15. CLINICAL TIPS
MAIN OBSTRUCTION
•Edema
•Exercise induced pain
•Mostly thigh not that much calfs
•Venous claudication
•Usually gets better getting foot up
•Not that much varicose veins

16. CLINICAL TIPS
MAIN REFLUX
•Restless legs
•Heaviness
•Big Varicose Veins
•Symptoms get worse aloing the day
•Skin changes
•Edema

17. MEDICAL TREATMENT
Non Medical Treatment considered on the SVS/AVF Guidelines

18. MEDICAL TREATMENT
UIP / IUA GUIDELINES
- Pentoxifylline GRADE A
- MPFF GRADE A
- Sulodexide GRADE A
- Rutosides GRADE B

19. MEDICAL TREATMENT

20. MEDICAL TREATMENT

21. WOUND CARE
Volume 37, June 2018. No 3
Evidence Based Guidelines for the Treatment of Chronic
Venous Diseases of the Lower Limbs
Several recent studies have emphasized
compression as the cornerstone for the
treatment of patients with venous leg ulcers
Compression increases and accelerates the
healing process compared with patients not
using compresion

22. WOUND CARE
European Society for Vascular Surgery (ESVS) 2022
Clinical Practice Guidelines on the Management of
Chronic Venous Disease of the Lower Limbs. EJVES,
63(1), p1-178, e1-e14, January 2022

23. WOUND CARE
Volume 37, June 2018. No 3
Evidence Based Guidelines for the Treatment of Chronic
Venous Diseases of the Lower Limbs
Multilayer bandages are superior to
single layer bandages
Two layer bandages are as good as four
layer bandages

24. WOUND CARE
Volume 37, June 2018. No 3
Evidence Based Guidelines for the Treatment of Chronic
Venous Diseases of the Lower Limbs
Unna Boot

25. WOUND CARE
Volume 37, June 2018. No 3
Evidence Based Guidelines for the Treatment of Chronic
Venous Diseases of the Lower Limbs
Unna Boot

26. WOUND CARE
- Wound Cleansers
- Debridement
- Surgical IB
- Hydrosurgical 2B
- Ultrasonic 2C
- Enzymatic 2C
- Biologic 2B

27. WOUND CARE
- Treatment of wound Infection
- Systemic AB’s
- Topical AB’s
- Dressings with AB’s
- Topical dressing selection
- Adjuvant Therapies

28. WOUND CARE
- Split-thickness skin graft
- Negative Pressure Therapy
- Electrical Stimulation
- Ultrasound Therapy
- AGAINST

29. WOUND CARE

30. THANK YOU