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Assessment of disease mechanisms and compression treatment in venous disease

Abu-Own, Abdusalam Abubakr; (1995) Assessment of disease mechanisms and compression treatment in venous disease. Doctoral thesis (Ph.D), UCL (University College London). Green open access

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Abstract

Compression of the lower limb is important in the treatment of chronic venous insufficiency and prophylaxis of deep vein thrombosis. The mechanism by which compression treatment works remains poorly understood. The aims of this work were to use non-invasive techniques to assess disease mechanisms and examine the effects of compression in patients with venous disease. 177 subjects (comprising patients with venous disease and normal control subjects) were entered into seven studies. In the first phase (Studies I -V), laser Doppler fluxmetry was used to examine the characteristics of skin blood flow and the effects of leg elevation and leg compression. The results showed that patients with chronic venous insufficiency have increased blood flow in liposclerotic skin due to an increase in the volume, rather than speed, of blood cells in the skin. Both leg compression and leg elevation increased the microcirculatory blood cell velocity in the supramalleolar region; this may be part of the mechanism by which leg compression and leg elevation are beneficial in the treatment of patients with venous ulceration. In contrast to the supramalleolar region, the heel microcirculation is vulnerable to compression. Lying on a conventional hospital bed reduced the laser Doppler flux signal to a minimal value while using a low air-loss support system maintained the interface pressure sufficiently low to prevent complete cessation of the heel microcirculation. The second phase of the work (studies VI and VII) was concerned with compression in deep vein thrombosis (DVT) prophylaxis. Strain gauge plethysmography (SGP) and colour duplex ultrasound imaging were used to study the haemodynamic effects of intermittent pneumatic compression and graduated compression (TED) stockings. The results indicated there was a haemodynamic advantage in the use of sequential intermittent compression compared to uniform single-chamber calf compression. The results also indicated a haemodynamic advantage in the combined use of TED stockings and intermittent pneumatic compression of the foot compared to using either of the two methods alone.

Type: Thesis (Doctoral)
Qualification: Ph.D
Title: Assessment of disease mechanisms and compression treatment in venous disease
Open access status: An open access version is available from UCL Discovery
Language: English
Additional information: Thesis digitised by ProQuest.
Keywords: Health and environmental sciences
URI: https://discovery.ucl.ac.uk/id/eprint/10104550
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