MEDECINE VASCULAIRE (anciennement ANGEIOLOGIE)

Basic principles, mode of action and effects of medical compression in pathology vascular

Didier RASTEL — 2020-02-01

Medical compression in vascular diseases is an old treatment but its physiological action is still poorly understood. The catalog of effects on the body is rich in particular in terms of macro and microcirculatory action but the relationship between physiological effects and clinical benefit remains unclear. The dose-response relationship is difficult to measure in studies, and the variability of pressure on members from one individual to another makes the generalization of results difficult. However, two main effects of compression can be highlighted: its ability to help drainage at the micro-circulatory level and its role in reducing trans-mural pressure.

Classification of bandages and compression stockings

Jean-Patrick BENIGNI — 2020-02-01

Before considering a semantic clarification is essential to speak a common language, mainly for bandages. The terms “multibandages” should be used instead of multilayer bandages because even a single bandage is always multilayered. The classification of bandages is based on four main criteria: stretch, composition, number of layers and stiffness of the bandage. The classification of stockings, for its part, is essentially based on two notions: pressure and degressive profile of pressure. These classifications are essential if we want to compare the results of clinical trials.

Compression therapy and thrombo-embolic venous diseases

Didier RASTEL — 2020-02-01

The treatment of venous thromboembolic disease is dominated by pharmacological strategies. In real life, medical compression is very lax with regard to recommendations, particularly in terms of pressure prescribed to patients. If the place of compression in the prevention of deep vein thrombosis is currently reduced, it remains indispensable for the management of pathology in its acute phase as well as for the prevention and treatment of post thrombotic morbidity. The studies provide important clues for early onset of the earliest possible compression therapy in the acute phase of venous thrombosis

Compression Treatment in Chronic Venous Disorders (CEAP C0s to C4)

Mieke FLOUR — 2020-02-01

Les bas et les bandes de compression médicale ont leur place reconnue dans presque toutes les indications de la maladie veineuse chronique.
Une sélection de la littérature récente dans les indications CEAP C0s – C4 permet une mise à jour de quelques preuves d’évidence en tenant compte du dosage et du profil de la compression exercée.
Les dispositifs de compression nouveaux et en voie de développement sont très prometteurs mais nécessitent des études cliniques randomisées et/ou comparatives afin de fonder leur valeur.

Women’s daily medical compression

Christian GARDON-MOLLARD — 2020-02-01

Medical venous compression: this garment is also a “drug”, an evidence often forgotten by the Physician and ignored or misunderstood by the patient ... this “sock” contains and has an active ingredient that we imagine and that the we do not represent each other well. The compliance can be summed up simply: it is necessary to wear this treatment, and it will be all the more as it is beautiful, comfortable, pleasant and its size.
It’s a team work. Every step from prescription to delivery must be educational. Each Physician and stakeholder must make use of particular knowledge, beliefs and skills. When these conditions are optimal and combined, the elastic venous compression brings all its effectiveness which is more to prove and becomes moreover a “pleasure compression”

Medical compression and pregnancy

Jean-Patrick BENIGNI — 2020-02-01

The High Authority for Health (HAS) and the French National College of Gynecologists and Obstetricians have given opinions on the importance of wearing compression during pregnancy and postpartum (respectively in 2010 and in 2016). About the prevention of deep or superficial venous thrombosis. The available recommendations support the use of 15-20 mmHg compression at the ankle during pregnancy and up to 6 weeks postpartum for surgery including caesarean section. The data available in pregnant women on the preventive or curative treatment of chronic venous disease are most often a matter of professional agreement. In the light of these data, the HAS considered that the systematic wearing of a compression of 15-20 mmHg, of 20-36 mmHg or more was justified. One particular point, the HAS considered that maternity tights are no more effective than stockings or thighs as well in the treatment of venous thrombosis as chronic venous disease during pregnancy.

Compression and leg ulcer

Frédéric VIN — 2020-02-01

Leg ulcer is a common condition in the general population, especially as its prevalence increases with age and the population ages.
A clinical diagnosis is needed to evaluate the appearance of ulceration and peri-ulcerous teguments. The clinical examination associated with an Duplex scanning aims to specify the purely venous origin (primary or secondary), arterial, capillary or mixed.
Beside local care, compression is the basis of leg ulcer treatment.

Compression and lymphedema

Stéphane VIGNES — 2020-02-01

Lymphoedema, primary and secondary, is a chronic disease whose treatment is symptomatic.
One-design elastic bandages with short stretch bands (<100%) – recommended by the Haute Autorité de Santé (HAS) – reduce the volume of lymphoedema.
The elastic compression with high pressures (> 20 mmHg, use of the superposition of bottom) is essential for the stabilization of the volume in the long course. Its delivery must be made by orthotists or orthopedic chemestry accustomed to lymphoedema.
Integration into a therapeutic education program is essential to improve patient independence and compliance.
New devices are being evaluated for the management of lymphedema.

Venous disease and compression therapy in the elderly

Dr Maxime CHAHIM — 2020-02-01

Practice in a geriatric environment shows the importance and high incidence of vascular diseases and especially those of chronic venous insufficiency of the lower limbs and its complications, as well as those of venous thrombo-embolic disease. This elderly population has two essential essential features: polypathology and many drugs.
In this context, compression therapy is important, especially to prevent venous ulcers and venous thromboembolism after surgery or acute medical ill conditions. Indeed, venous thromboembolism therapy by long-term anticoagulant treatments involves, in addition to major hemorrhagic risks, risks in case of renal failure or drug, interactions. However, the compression therapy of elderly patients is not always easy to adopt, with its precautions, its contraindications, its risks, its practical difficulties and especially of observance. Other pathologies frequently met this difficult or impossible task: decompensated heart failure, sensory neuropathy, diabetic angiopathy; and especially as their symptoms may be masked or attenuated in the physiologically elderly subject. The goal is effective and well tolerated compression therapy. The key is not to harm “Primum non nocere”.

SUMMARY

ESKA EDITION — 2020-04-01

summary