Taken into account multidiscilinary aspect of Vascular Compression
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1 The Vascular Center : A model to improve patient care Taken into account multidiscilinary aspect of Vascular Compression F. Vin C. Gardon-Mollard
2 Compression Therapy is an efficient treatment for the management of Chronic Venous Insufficency Story Jews, greeks and Romans used compression for the traeatment of leg ulcers Hippocrate used canvas bandaging for the treatment of leg ulcers In 1885 Paul UNNA use the Unna Boot with zinc oxyde In 1910 Heinrich FISCHER use compression + walking for the treatment of deep venous thrombosis
3 HAS 2010 Compression is the basic treatment of chronic venous insufficency Bandaging must be used for a short time Elastic stocking and panties are used for a long term treatment Patient education is necessary to wear compression therapy
4 PHYSIOLOGICAL ASPECTS OF ELASTIC AND NON INTERNATIONAL CONSENSUS CONFERENCE PARIS 2002 Application of pressure to produce a clinical effect : Decrease deep veins diameter in lying position Decrease superficial veins diameter Increase blood flux
5 PHYSIOLOGICAL ASPECTS OF ELASTIC AND NON ELASTIC COMPRESSIOIN INTERNATIONAL CONSENSUS CONFERENCE PARIS 2002 Effects on sub-cutaneous tissues : Reduce edema Increase clearance of Na 24
6 Differents devices for compression Bandaging Elastic stocking
7 Different type of bandaging Permanent bandage Adhésif permanent bandage Cohesif permanent bandage Unna Boot No permanent Bandage Non elastic bandaging (coton) Short stretch Long stretch Multilayer bandage Multitype bandage
8 Different type of hosery Elastic stocking Panty
9 Classes of compression Stretching > 140% CLASSE Pressure mm Hg mm Hg mm Hg 4 Over 36 mm Hg
10 Place of compression in a Vascular Center Chronic venous insufficency Venous surgery Trophic troubles : Leg ulcers Lipodermatosclerosis Varicose vein bleeding Superficial and deep venous thrombosis Lymphedema
11 Indication I Chronic venous insufficency CEAP Classification CEAP 0 S and 1 S : Elastic stocking Classe 1 or or mmhg CEAP 2 S or 2 AS : Elastic stocking Classe mmhg CEAP 3 S or 3 AS : Elastic stocking classe mmhg
12 Indication II Lipodermatosclerosis C4b Permanent non elastic compression + pad + walking Dressing once a week until softing skin Elastic stocking Classe 3 (20-36 mmhg ) on day to prevent recurrence Elastic stocking Classe 1 + Classe 2
13 Indication III Leg ulcer C HAS recommend to use multilayer compression for the treatment of venous leg ulcers (P > 30 mmhg). Cochrane review Meta-analyse in 2009 give advantage for four layer bandaging
14 Multitype bandaging Multilayer (4 layer) bandaging : Profore R Multitype bandaging (2 layer) UrgoK R 2 Coban 2 R
15 Indication IV Venous surgery The beneficial effect of compression after surgery include prevention of SVT and DVT Reduce hemorrhagic complications Reduction in pain, ecchymoses, and hematomas Acceleration of the return to socio-professionl activities Experts recommend that bandages be used immediately after surgery : Low pressure(15mmhg) stocking during 1 week International Angiology N 4 December 2004 pp:
16 Indication V Superficial venous thrombosis Preventive anticoagulation 4 to 6 weeks + Permanent non elastic compression bandaging night and day 10 days Thrombectomie D + 10 and elastic stocking to prevent recurrences
17 Indication VI Deep venous thrombosis AFSSAPS and CHEST recommandations Anticoagulation par UFH,LMWH or Fondaparinux + AVK day 1 Rivaroxaban AFSSAPS 2099 : Anticoagulation + elastic stocking mmhg recommended as soon as possible (Grade A) with deambulation (grade B) CHEST : anticoagulation + elastic compression stocking (30-40 mmhg) 2 years Grade 1A + deambulation
18 Indication VII Prevention DVT AFFSAPS 2009 : LMWH or Fondaparinux + Elastic compression stocking (15-20 mmhg) International consensus conference 2004 : Graduated compression stocking reduce the risk of DVT in moderate risk surgical interventions ( Grade A)
19 Indication VIII Lymphoedema Compression increases the displacement of fluids in the limb toward the trunks via the lymphatic vessel Reduction of limb volume Reduction in the size of of the subcutaneous compartment During initial phase : non elastic bandaging with several layer During maintenance : elastic high level compression (36-40 mmhg)
20 Conclusion Compression is an efficient treatment for chronic venous insufficiency, trophic troubles, leg ulcers and venous surgery The mechanical effet decrease the size of superfial veins and reduce edema with improvement of the micro capillary circulation Compression is the best treatment without side effects
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