Studiesonthepreventionofvenousinsufficiencyandulceration

  • Muhammad Sultan

Student thesis: Doctor of Medicine

Abstract

TheUniversityofManchester,Abstractsubmittedby'MuhammadJunaidSultan'forthedegreeofMD;entitled"Studiesonthepreventionofvenousinsufficiencyandulceration",June2013Introduction:Venousdiseaseimpairsthequalityoflife,necessitatestimeoffworkandcausesvenousulcers.Thefocusofthisthesisistoexplorestrategiestopreventchronicvenousinsufficiency(CVI)andvenousulceration.Aims1. Toidentifyapopulationatriskofdevelopingvenousulcers2. Tostudythepressureprofilerequiredbyelasticstockingstohalvetransitvenoustime3. ToexploretheroleofcompressionfollowinganklefractureMethods:Datawascollectedfrom231patientswithvenousulcersandageandsexmatched210controlstoidentifyriskfactorsforvenousulceration.Univariateandmultivariateanalysisofpotentialriskfactorswasundertakentoidentifythosethatindependentlypredictthisrisk.Afteridentifyingthepopulationatrisk,prophylacticstrategiesweredeveloped.TheeffectofEngineeredCompressionStockings(ECS)delivering15mmHg,25mmHgand35mmHgpressureattheankleonthecalfvenoustransittimeandvolumewasmeasuredtodeterminetheidealpressureprofilerequiredtohalvetransitvenoustime,whichshouldbeappropriateforDVTprophylaxis.Adorsalfootveinwascannulatedin15healthyvolunteerswithnovenousdisease.Thetransittime(secs)forultrasoundcontrastfromafootveintothepoplitealveinwasmeasuredusingduplexultrasound.Calfvolumeswererecordedbywaterdisplacement.ECSdelivering25mmHgofpressurearoundtheanklewerecomparedwithnocompressioninarandomizedcontrolledtrial(RCT)in90patientswithin72hoursofanklefracture.Patientswererandomisedtoeitheri)ECSandair-­‐castbootorii)alinerandair-­‐castbootandwerefollowedat2,4,8,12weeksand6months.TheprimaryoutcomewasfunctionalrecoverymeasuredusingtheOlerudMolanderAnkleScore(OMAS).Secondaryoutcomeswerei)TheAmericanOrthopaedicFootandAnkleScore(AOFAS),ii)SF12v2QualityofLifescore(QoL),iii)pain,andiv)frequencyofDVT.ResultsTheriskfactorssignificantlyassociatedwithvenousulcerationonmultivariateanalysisincludedahistoryofDeepVeinThrombosis(DVT),phlebitis,hipreplacement,poormobility,weight/kg>100Kg,varicoseveins(VV),familyhistoryofVVandweight(kg)between75-­‐100kg.Asimplediagnosticscoringsystemwasderivedfromthisregressionanalysiswithscoresofgreater than or equal to3predictinga6.7%annualriskandof
Date of Award31 Dec 2013
Original languageEnglish
Awarding Institution
  • The University of Manchester
SupervisorCharles Mccollum (Supervisor)

Keywords

  • CVD Chronic Venous Disease
  • ECS Engineered Compression Stockings

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