Compression-Therapy
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Recurrent Leg Cellulitis: Pathogenesis, Tre.Atment, and Prevention
J Am Board Fam Pract: first published as 10.3122/jabfm.5.1.85 on 1 January 1992. Downloaded from Recurrent Leg Cellulitis: Pathogenesis, Tre.atment, And Prevention Roben P. Pierce, M.D., and Allen]. Daugird, M.D. Recurrent cellulitis can develop in a variety of therapy. Subsequently, she developed chronic bi settings. Recurrent febrile episodes associated lateral lower leg edema before her first hospital with arm or leg infections, sometimes described ization at our institution. as erysipelatous, have been noted for years to Upon admission, she denied fever, chills, nau occur in the setting of filarial, postoperative, or sea, vomiting, shortness of breath, or chest pain. idiopathic chronic lymphedema. I More recently, She reported bilateral tubal ligation and ovarian recurrent cellulitis has been described as a late cyst removal more than 20 years ago. Five years complication of coronary artery bypass venec ago she had a radical mastectomy for adenocarci tomy,2-8 pelvic surgery, such as vulvectomy with noma of the breast but had negative lymph nodes lymphadenectomy9 or hysterectomy with lym and underwent no further treatment. There was ph adenectomy, 10 or of pelvic irradiation after hys no history of cellulitis of the right arm after the terectomy.11,12 The cause of recurrent cellulitis mastectomy. She denied any other pelvic surgery, has not been precisely defined but appears to be leg surgery, or abdominal or pelvic irradiation. multifactorial, involving mechanical, infectious, On examination, her temperature was 37.4°C and immune-mediated factors. We present a case (99.32°F), blood pressure 144/84 mmHg, pulse 80 of a woman with recurrent cellulitis of the legs beats per minute, and respirations 24/minute. -
Venous Thromboembolism (VTE) Measure Set
Venous Thromboembolism (VTE) Measure Set Kathy Wonderly RN, MSEd, CPHQ Consultant Developed: June, 2012 Most recent update: December 2014 Major philosophy change The Center for Medicare and Medicaid (CMS) is moving away from collecting data on the process of care and focusing more on the outcomes of the care provided. Starting in January 2015, CMS will have five indicators required and one may be voluntarily submitted if your facility wished. Depending on the reporting option that your facility chooses, all 6 measures may be required for The Joint Commission’s Accreditation. Objectives To identify the value of starting VTE prophylaxis on the day of or the first day after admission or surgery end date. To list the 3 of the 4 elements included on the written warfarin discharge instructions. Prevention is the Goal To prevent such complications, the best approach is to assess each patient for VTE risk and administer primary prophylaxis to reduce the chance for developing either a DVT or PE. Introduction Hospitalized patients at high risk for VTE may develop asymptomatic deep vein thrombosis (DVT) or pulmonary embolism which may cause an unexpected death before the diagnosis is even suspected. As with the other measure sets, patients ordered “Comfort Measures only” are excluded from these requirements. The Desired Patient Outcome It is estimated that there are more than 600,000 to 1 million patients who suffer a VTE annually and approximately 50% of these are health care acquired. The goal of the CMS Partnership for Patients program is to reduce the occurrence of these HA events by 40%. -
Treatment Strategies for Patients with Lower Extremity Chronic Venous Disease (LECVD)
Evidence-based Practice Center Systematic Review Protocol Project Title: Treatment Strategies for Patients with Lower Extremity Chronic Venous Disease (LECVD) Project ID: DVTT0515 Initial publication date if applicable: March 7, 2016 Amendment Date(s) if applicable: May 6th, 2016 (Amendments Details–see Section VII) I. Background for the Systematic Review Lower extremity chronic venous disease (LECVD) is a heterogeneous term that encompasses a variety of conditions that are typically classified based on the CEAP classification, which defines LECVD based on Clinical, Etiologic, Anatomic, and Pathophysiologic parameters. This review will focus on treatment strategies for patients with LECVD, which will be defined as patients who have had signs or symptoms of LE venous disease for at least 3 months. Patients with LECVD can be asymptomatic or symptomatic, and they can exhibit a myriad of signs including varicose veins, telangiectasias, LE edema, skin changes, and/or ulceration. The etiology of chronic venous disease includes venous dilation, venous reflux, (venous) valvular incompetence, mechanical compression (e.g., May-Thurner syndrome), and post-thrombotic syndrome. Because severity of disease and treatment are influenced by anatomic segment, LECVD is also categorized by anatomy (iliofemoral vs. infrainguinal veins) and type of veins (superficial veins, perforating veins, and deep veins). Finally, the pathophysiology of LECVD is designated typically as due to the presence of venous reflux, thrombosis, and/or obstruction. LECVD is common -
Compression Therapy for Venous Disease
Compression therapy for venous disease Mauro Vicaretti, Senior Lecturer, Vascular and Endovascular Surgery, Sydney Medical School, University of Sydney Summary n active or healed venous leg ulcers n lymphoedema Compression therapy, by bandaging or stockings, n prevention of deep vein thrombosis and oedema on is routine for thromboprophylaxis and for long-haul flights (more than four hours). chronic venous disease and its complications, Assessing the patient including deep venous thrombosis. The degree Before compression therapy is commenced, thorough vascular of compression is dependent on the condition assessment to exclude significant peripheral arterial disease being treated and underlying patient factors. It is essential. If pedal pulses are weakened or absent, an ankle- is important that a thorough clinical vascular brachial pressure index should be calculated. Divide the ankle examination with or without non-invasive systolic pressure of the dorsalis pedis or posterior tibial artery vascular investigations be performed to (the greater value taken as the ankle pressure) by the brachial rule out significant arterial disease that may systolic pressure (Figs. 1A–C). contraindicate the use of compression therapy. If the patient has arteriosclerosis or diabetes, it is imperative that a great toe pressure index (photoplethysmography) also Key words: chronic venous disease, compression, deep vein be performed. This is measured using a photoelectric cell thrombosis, leg ulcer. that consists of a light emitting diode and a photosensor that (Aust Prescr 2010;33:186–90) transduces changes in dermal arterial flow. A toe cuff is inflated then deflated (Fig. 1D). A waveform appears when the toe Introduction systolic pressure is reached. This pressure is divided by the Compression therapy has been used to treat chronic venous brachial pressure to give the toe brachial pressure index. -
Compression Stockings and Garments Policy
Manual: IU Health Plans Department: Utilization Management Policy # UMDET014.1 Effective Date: 08/27/2020 Supersedes Policy # UMDET014.0/or Last update or issue date: 08/23/2019 Page(s) Including attachments: 8 Medicare Advantage X Commercial Compression Stockings and Garments Policy I. Purpose Indiana University Health Plans (IU Health Plans) considers clinical indications when making a medical necessity determination for Compression Stockings and Garments. II. Scope All Utilization Management (UM) staff conducting physical and behavioral health UM review. III. Exceptions A. Gradient Compression Garments/Stockings for a member are not covered for any of the following: 1. Any over-the-counter garment/elastic stocking or compression bandage roll, even if prescribed by a provider. 2. Any garment/stocking that is supplied without a written physician’s order. 3. Gradient compression garments/stockings are not covered and not considered medically necessary for one of the following conditions with or without a written physician’s order: a. Osteoarthrosis b. Fibromitosis c. Chronic airway obstruction d. Carpal tunnel syndrome e. Urine retention f. Cellulitis g. Neurogenic bladder h. Paralysis agitans i. Sprained and or strained joints or ligaments j. Tendinitis k. Sleep apnea l. Hammer toe m. Lupus Erythematous n. Hyperlipidemia o. Dermatitis (other than stasis dermatitis from venous insufficiency) p. Asthma q. Esophageal reflux r. Cystocele s. Osteomyelitis t. Backache u. Chest pain v. Spider veins Note: Gradient Compression Garments are limited to four pairs per benefit period. IV. Definitions None V. Policy Statements A. IU Health Plans considers Compression Stockings and Garments medically necessary for the following indications: 1. Gradient Compression Garments/Stockings are covered when all of the following criteria are met: a. -
Compression Stockings for Preventing the Postthrombotic Syndrome In
CLINICAL RESEARCH STUDY Compression Stockings for Preventing the Postthrombotic Syndrome in Patients with Deep Vein Thrombosis Christopher Friis Berntsen, MD,a,b Annette Kristiansen, MD,a,b Elie A. Akl, MD, MPH, PhD,c Per Morten Sandset, MD, PhD,d,e Eva-Marie Jacobsen, MD, PhD,d,e Gordon Guyatt, MD, MSc,f Per Olav Vandvik, MD, PhDa,b aDepartment of Internal Medicine, Sykehuset Innlandet Hospital Trust, Gjøvik, Norway; bInstitute of Health and Society, Faculty of Medicine, University of Oslo, Norway; cDepartment of Internal Medicine, American University of Beirut, Lebanon; dDepartment of Haematology, Oslo University Hospital, Norway; eInstitute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway; fDepartment of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada. ABSTRACT OBJECTIVE: We conducted a systematic review and meta-analysis to address benefits and harms of using elastic compression stockings after lower-extremity deep vein thrombosis. METHODS: We searched 7 electronic databases through January 15, 2015, including randomized controlled trials (RCTs)/quasi-randomized trials reporting on elastic compression stocking efficacy on postthrombotic syndrome incidence, recurrent venous thromboembolism, mortality, and acute pain after deep vein thrombosis. Two reviewers independently screened records, extracted data, assessed risk of bias, and assessed confidence in effect estimates using Grading of Recommendations Assessment, Development, and Evaluation methodology. We applied random-effects meta-analysis models. RESULTS: We included 5 RCTs (n ¼ 1418) reporting on postthrombotic syndrome. The hazard ratio (HR) for postthrombotic syndrome with elastic compression stockings was 0.69 (95% confidence interval [CI], 0.47-1.02). We have very low confidence in this estimate due to heterogeneity and inclusion of unblinded studies at high risk of bias. -
Focus on Compression Stockings
Focus on Compression Stockings Deep Vein Thrombosis and Post-Thrombotic Syndrome What you need to know about compression therapy for DVT and PTS What are Elastic Compression Stockings? What is Post-Thrombotic Syndrome (PTS) Compression apparel is used to prevent or control edema The post-thrombotic syndrome (PTS) is a complication (leg swelling). These items of clothing may be stockings from having had a blood clot or DVT. Many people who sleeves, pantyhose or leotards, depending on the have had a DVT in the leg or arm recover completely, location and type of swelling that you have. Compressing but others may still have pain and discomfort in that different parts of the body helps improve circulation arm or leg. by preventing the buildup of fluid in the arms or legs. These lingering problems are known as the post- For the purpose of this flyer we will be focusing only thrombotic syndrome. Overall, PTS occurs in 20-40 on compressionfighting stockings. VASCULAR DISEASE...improving VASCULAR HEALTH percent of patients who develop DVT in their legs, and Sometimes, for one reason or another, the body may retain fluid in a specific area, such as the legs, arms, or it is the most common DVT complication. abdomen. This swelling is referred to as edema. If you have edema, compression therapy may be recommended as part of a treatment plan. There are several situations when compression may be helpful, including: tired legs, varicose veins, chronic venous insufficiency (CVI), lymphedema, or deep vein thrombosis (DVT). This brochure focuses on compression therapy for DVT and PTS. -
Comparison of the Effect of Compression Stockings with Heparin and Enoxaparin in the Prevention of Deep Vein Thrombosis in Lower Limbs of Hysterectomy Patients
www.revhipertension.com Revista Latinoamericana de Hipertensión. Vol. 14 - Nº 1, 2019 Comparison of the effect of compression stockings with heparin and enoxaparin in the prevention of deep vein thrombosis in lower limbs of hysterectomy patients 37 Comparación del efecto de las medias de compresión con heparina y enoxaparina en la prevención de la trombosis venosa profunda en extremidades inferiores de pacientes con histerectomía Enhesari A., M.D.1, Honarvar Z., M.D.2, Shamsadini Moghadam N., M.D3* 1Associate Professor, Department of Radiology, Afzalipour School of Medicine & Physiology Research Center, Kerman University of Medical Sciences, Kerman, Iran. 2Assistant Professor, Department of Gynecology, Afzalipour School of Medicine, Kerman University of Medical Sciences, Kerman, Iran. 3Resident, Department of Radiology, Afzalipour School of Medicine, Kerman University of Medical Sciences, Kerman, Iran. *Corresponding Author: Shamsadini Moghadam N., Resident, Department of Radiology, Afzalipour School of Medicine, Kerman University of Medical Sciences, Kerman, Iran. Email: [email protected] Introduction: Deep vein thrombosis is a common com- Introducción: la trombosis venosa profunda es una queja plaint in patients which can be caused by factors such as común en pacientes que puede ser causada por factores surgery. Medical and mechanical methods such as stoc- como la cirugía. Los métodos médicos y mecánicos, como kings are used to prevent this complication. Although se- las medias, se utilizan para prevenir esta complicación. Abstract veral studies have examined and compared the effects of Resumen Aunque varios estudios han examinado y comparado los these methods, is no study has compared these methods efectos de estos métodos, ningún estudio ha compara- in hysterectomy. -
Lower Extremity Ulcers: Venous, Arterial, Or Diabetic?
Lower Extremity Ulcers: Venous, Arterial, or Diabetic? Determining the answer to this question is crucial to avoid administering treatment that only makes a serious condition worse. After pointing out where to look for the keys in the history and physical, the authors review how the etiology of an ulcer should influence the therapeutic approach. By Ani Aydin, MD, Srikala Shenbagamurthi, MD, and Harold Brem, MD hen a patient presents to the duration, progression, prior treatments, and clinical emergency department with a course of the ulcer can suggest its etiology. Pos- lower extremity cutaneous ul- sible considerations to rule out include diabetes; cer, many etiologies must be hypertension; hyperlipidemia; coronary artery dis- Wconsidered. These include venous and arterial dis- ease; alcohol and tobacco use; thyroid, pulmonary, ease, diabetes mellitus, connective tissue disorders, renal, neurologic and rheumatic diseases; peripheral rheumatoid arthritis, vasculitis, and malignancies. vascular disease; deep vein thrombosis; and specifi- One goal of the initial assessment is to determine cally cutaneous factors including cellulitis, trauma, whether the ulcer is chronic (defined as taking a and recent surgery. The patient should be asked significant amount of time to heal, failing to heal, about lower extremity pain, paresthesia, anesthesia, or recurring), as such ulcers are associated with sig- and claudication. nificant morbidity.1,2 Physical examination, too, may suggest the etiol- Most prominent in the differential diagno- ogy of an ulcer. Wound characteristics that should sis should be venous reflux, arterial insufficiency, be noted include size, location, margins, presence of pressure ulcer, and ulcer granulation tissue, necrosis, weeping, odor, and pain. >>FAST TRACK<< secondary to diabetic neu- Pulses must be palpated in the distal extremities. -
Understanding Chronic Venous Disease: a Critical Overview of Its Pathophysiology and Medical Management
Journal of Clinical Medicine Review Understanding Chronic Venous Disease: A Critical Overview of Its Pathophysiology and Medical Management Miguel A. Ortega 1,2,3,† , Oscar Fraile-Martínez 1,2,† , Cielo García-Montero 1,2,† , Miguel A. Álvarez-Mon 1,2,*, Chen Chaowen 1, Fernando Ruiz-Grande 4,5, Leonel Pekarek 1,2 , Jorge Monserrat 1,2 , Angel Asúnsolo 2,4,6 , Natalio García-Honduvilla 1,2,‡ , Melchor Álvarez-Mon 1,2,7,‡ and Julia Bujan 1,2,‡ 1 Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain; [email protected] (M.A.O.); [email protected] (O.F.-M.); [email protected] (C.G.-M.); [email protected] (C.C.); [email protected] (L.P.); [email protected] (J.M.); [email protected] (N.G.-H.); [email protected] (M.Á.-M.); [email protected] (J.B.) 2 Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain; [email protected] 3 Cancer Registry and Pathology Department, Hospital Universitario Principe de Asturias, 28806 Alcalá de Henares, Spain 4 Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain; [email protected] 5 Department of Vascular Surgery, Príncipe de Asturias Hospital, 28801 Alcalá de Henares, Spain 6 Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, The City University of New York, New York, NY 10027, USA 7 Citation: Ortega, M.A.; Immune System Diseases—Rheumatology and Internal Medicine Service, University Hospital Príncipe de Fraile-Martínez, O.; García-Montero, Asturias, (CIBEREHD), 28806 Alcalá de Henares, Spain * Correspondence: [email protected] C.; Álvarez-Mon, M.A.; Chaowen, C.; † These authors contributed equality in this work. -
Venous Stasis Disease
What To Do About Venous Stasis Disease Siobhan Ryan, MD, FRCPC; Gary Sibbald, MD, FRCPC; and Patricia Couts, RN As presented at the 16th Annual Symposium of Advanced Wound Care, Las Vegas (April 29, 2003) hronic lower limb edema is a common bilateral, but in the early, acute stages it may Cproblem due to congestive heart failure, present as a unilateral, reddish to purple, low albumin, or venous stasis. Often this swollen lower limb. However, it is unrespon- edema is caused by venous stasis or chronic sive to antibiotics, and would not be associat- venous insufficiency, and the etiology is vari- ed with any systemic symptoms. Venous stasis able (Table 1). Chronic venous insufficiency presents clin- Table 1 ically as a spectrum of features (Figure 1). Causes of venous diseases Lipodermatosclerosis, cellulitis, venous Valvular insufficiency stasis dermatitis, and acute contact dermatitis • Superficial, perforating, or deep veins on the lower limb may, at times, be difficult to • Atrioventricular shunts differentiate. Lipodermatosclerosis is usually Calf muscle pump failure Post-surgical • Varicose vein surgery Margaret’s case • Vein harvesting Trauma Margaret, 57, has a • Crush injury long history of swollen • Shotgun wound ankles that she initially • Radiation noticed with the first of her four pregnancies. Obstruction The degree of swelling • Acute (phlebitis or infection/cellulitis) has progressed over • Abdominal obstruction time and has been Post-phlebitic syndrome aggravated by prolonged standing at Obesity work. Over the last Medication year, she has noticed • Steroids, estrogens, calcium channel an itchy, reddish discolouration on the lower blockers part of both her legs. Lifestyle/occupation For a followup on Margaret, see page 88. -
Compression Stockings and Garments Policy Number: MP-015 Last Review Date: 05/09/2019 Effective Date: 04/20/2020
Compression Stockings and Garments Policy Number: MP-015 Last Review Date: 05/09/2019 Effective Date: 04/20/2020 Policy Evolent Health considers Compression Stockings and Garments medically necessary when all of the following criteria are met: 1. There is a written prescription from the treating physician; AND 2. A written, signed and dated order must be received by the supplier before billing for Gradient Compression Garments/Stockings; AND 3. A qualified health care professional must measure the member’s extremity for appropriate sizing/fit, and this must be documented in the medical record; AND 4. When at least one of the following conditions are met: • Open ulcer • To secure a primary dressing over an open venous stasis ulcer that has been treated by a physician or other health care professional requiring medically necessary debridement • Lymphedema treatment (for Post Mastectomy Lymphedema see also PA-075 Lymphedema Pumps and Appliances policy). • Prevention of stasis ulcers and reoccurrence of stasis ulcers that have healed • Statis dermatitis from Venous Insufficiency • Edema-chronic, following trauma, surgery, fractures, venous, severe with pregnancy, associated with paraplegia and quadriplegia • Treatment of burns, 2nd degree or greater (See also MP-011 Surgical Dressings and Would Care Supplies) • Deep venous thrombosis (DVT) prophylaxis during pregnancy and postpartum • Post thrombotic/ phlebitic syndrome • Post sclerotherapy • For prevention of thrombosis in immobilized persons • Phlebitis/Thrombophlebitis • Postural hypotension • Lipodermatosclerosis • Symptomatic Varicose veins (not spider veins) Limitations Non-Elastic Binders & Gradient Compression Garments (ready-to-wear or custom made): Compression Stockings and Garments Policy Number: MP-015 Last Review Date: 05/09/2019 Effective Date: 04/20/2020 • Non-elastic binders and gradient pressure garments which are ready-to-wear or custom made are only covered for lymphedema treatment when there is a written prescription from the treating physician.