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ePaper created 2014-09-15, 12:31:02 | version 1.32.01
patients with venous leg ulcers than in the control group and the general population.[3] Another study found a synergistic pathogenic role of factor V Leiden, hyperhomocysteinemia and impaired fibrinolysis in the development of post thrombotic syndrome and its sequelae. So an increased formation of thrombi in the microcirculation of the skin in combination with ambulatory venous hypertension play a role in ulcer formation.[4] Furthermore new techniques such as laser Doppler imaging were tested on their value in micro vascular research and evaluating local treatment of the skin, like topical steroids. Sometime after the Duplex technique had been introduced “Duplex guided sclerotherapy” was a logical next step in de armament of the dermatologist and this method was indeed introduced at the outpatient clinic in 1998. Around the turn of the century a new sclerosing technique, namely foam sclerosis, was invented by a Spanish surgeon. This method was soon introduced in Maastricht and called ultrasound guided foam sclerotherapy (UGFS). In a large randomized trial sponsored by the Dutch government, with more than 400 legs being treated, it could be shown that at 2-year follow-up, UGFS was not inferior to surgery when “reflux associated venous symptoms” was the clinical outcome of interest.[5] Also the side effects of foam echo sclerotherapy were investigated and well documented.[6] In another large study a series of patients after stripping of the long saphenous vein were included. Most of these patients were free of complaints after the surgery but more than half still had visible veins on their lower legs.[7] Later on also lymphedema became a topic for patient care, but also as a research item, mainly from a genetic point of view. A new syndrome could be confirmed.[8] In another clinical study it could be shown that patients presenting with a first episode of erysipelas often have signs of pre-existing lymphatic impairment in the other, clinically non affected, leg. This means that subclinical lymphatic dysfunction of both legs may be an important predisposing factor.[9] References 1. Veraart JCJM, Neumann HAM. Effect of medical elastic therapeutic stockings on interface pressure and ede ma prevention. Dermatol Surg 1996; 22: 867-71. 2. de Roos KP, Nieman FH, Neumann HA. Ambulatory phlebectomy versus compression sclerotherapy: results of a randomized controlled trial. Dermatol Surg. 2003; 29: 221-6. 3. Maessen-Visch MB, Hamulyak K, Tazelaar DJ, et al. The prevalence of factor V Leiden mutation in patients with leg ulcers and venous insufficiency. Arch Dermatol. 1999; 135: 41-4. 4. Kolbach DN., Veraart JCJM., Hamulyák K., et al. Recurrent leg ulcers in a young man with hyperhomocy steinemia , factor V Leiden and impaired fibrinolysis. Acta Dermato-Venereologica 2002; 82: 52-4. 5. Shadid N, Ceulen R, Nelemans P, et al. Randomized clinical trial of ultrasound-guided foam sclerotherapy versus surgery for the incompetent great saphenous vein. Br J Surg 2012; 99: 1062-70. 6. Ceulen RP, Sommer A, Vernooy K. Microembolism during foam sclerotherapy of varicose veins. N Engl J Med. 2008; 358: 1525-6. 7. Neer P van, A. Kessels, E. de Haan, et al. Residual varicose veins below the knee after varicose vein surgery are not related to incompetent perforating veins. J Vasc Surg 2006; 44: 1051-4. 149 BWEADVSMGFINCORR:Opmaak 1 21-07-2014 17:41 Pagina 149