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15. Wenhui L, Changgeng F, Lei X, Baozhong Y, Guobin L, Weijing F.Hyperbaric oxygen therapy
for chronic diabetic foot ulcers: an overview of systematic reviews. Diabetes Res Clin Pract.
2021;176:108862.
16. Wynn M, Freeman S.The efcacy of negative pressure wound therapy for diabetic foot ulcers:
a systematised review. J Tissue Viability. 2019;28:152–60.
17. Seidel D, Storck M, Lawall H, etal. Negative pressure wound therapy compared with standard
moist wound care on diabetic foot ulcers in real-life clinical practice: results of the German
DiaFu-RCT.BMJ Open. 2020;10:e026345.
18. Thanigaimani S, Jin H, Ahmad U, Anbalagan R, Golledge J.Comparative efcacy of growth
factor therapy in healing diabetes-related foot ulcers: a network meta-analysis of randomized
controlled trials. Diabetes Metab Res Rev. 2023;39(5):e3670.
19. Bhat S, Chia B, Barry IP, Panayi AC, Orgill DP.Free tissue transfer in diabetic foot ulcers: a
systematic review and meta-analysis. Eur J Vasc Endovasc Surg. 2023;66: 670–7.
20. Chuter V, Schaper N, Mills J, etal. Effectiveness of revascularisation for the ulcerated foot in
patients with diabetes and peripheral artery disease: a systematic review. Diabetes Metab Res
Rev. 2023; https://doi.org/10.1002/dmrr.3700. Epub ahead of print
21. Cheun TJ, Jayakumar L, Sideman MJ, Ferrer L, Mitromaras C, Miserlis D, Davies MG.Shortterm contemporary outcomes for staged versus primary lower limb amputation in diabetic foot
disease. J Vasc Surg. 2020;72:658–66.
22. Lazzarini PA, Jarl G, Gooday C, Viswanathan V, Caravaggi CF, Armstrong DG, Bus
SA.Effectiveness of ofoading interventions to heal foot ulcers in persons with diabetes: a
systematic review. Diabetes Metab Res Rev. 2020;36(Suppl 1):e3275.
23. Racaru S, Bolton Saghdaoui L, Roy Choudhury J, Wells M, Davies AH.Ofoading treatment
in people with diabetic foot disease: a systematic scoping review on adherence to foot ofoading. Diabetes Metab Syndr. 2022;16:102493.
24. Tu Y, Lineaweaver WC, Chen Z, Hu J, Mullins F, Zhang F.Surgical decompression in the
treatment of diabetic peripheral neuropathy: a systematic review and meta-analysis. J Reconstr
Microsurg. 2017;33:151–7.
25. Liao C, Zhang W, Yang M, Ma Q, Li G, Zhong W.Surgical decompression of painful diabetic
peripheral neuropathy: the role of pain distribution. PLoS One. 2014;9(10):e109827.
26. Dellon AL.Treatment of symptomatic diabetic neuropathy by surgical decompression of multiple peripheral nerves. Plast Reconstr Surg. 1992;89:689–97. discussion 698-9
27. Baltodano PA, Basdag B, Bailey CR, Baez MJ, Tong A, Seal SM, Meléndez MM, Xie L,
Manahan MA, Rosson GD.The positive effect of neurolysis on diabetic patients with compressed nerves of the lower extremities: a systematic review and meta-analysis. Plast Reconstr
Surg Glob Open. 2013;1:e24.
28. Rinkel WD, Franks B, Birnie E, Castro Cabezas M, Coert JH.Cost-effectiveness of lower
extremity nerve decompression surgery in the prevention of ulcers and amputations: a Markov
analysis. Plast Reconstr Surg. 2021;148:1135–45.
29. Sarmiento S, Pierre JA Jr, Dellon AL, Frick KD.Tibial nerve decompression for the prevention of the diabetic foot: a cost-utility analysis using Markov model simulations. BMJ Open.
2019;9:e024816.
30. Dallimore SM, Kaminski MR.Tendon lengthening and fascia release for healing and preventing diabetic foot ulcers: a systematic review and meta-analysis. J Foot Ankle Res. 2015;8:33.
31. Calvo-Wright MM, López-Moral M, García-Álvarez Y, García-Madrid M, Álvaro-Afonso FJ,
Lázaro-Martínez JL.Effectiveness of percutaneous exor tenotomies for the prevention and
management of toe-related diabetic foot ulcers: a systematic review. J Clin Med. 2023;12:2835.
https://doi.org/10.3390/jcm12082835.
17 The Diabetic Foot
Chapter 18
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Chronic Venous Disease andVaricose Veins
18.1 Guideline Recommendations
18.1.1 Clinical Practice Guidelines oftheEuropean Society
forVascular Surgery (ESVS) ontheManagement
ofChronic Venous Disease oftheLower Limbs [1]
18.1.1.1 Classication andDiagnostic Workup
Recommendation 1
For patients with chronic venous disease, the use of the CEAP (Clinical, Etiological,
Anatomical, Pathophysiological) classication (Tables 18.1 and 18.2) is recommended for clinical audit and research. (Recommendation class I/Level of evidence C).
Recommendation 2
For patients with chronic venous disease, grading of clinical severity and evaluation
of treatment success using the revised Venous Clinical Severity Score (r-VCSS) and
the Villalta scale for post-thrombotic syndrome should be considered for clinical
audit and research. (Recommendation class IIa/Level of evidence C).
Switzerland AG 2023
E. S. Debus, R. T. Grundmann, Evidence-based Therapy in Vascular Surgery,
https://doi.org/10.1007/978-3-031-47397-5_18
383© The Author(s), under exclusive license to Springer Nature
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Table 18.1 2020 update of the CEAP (Clinical—Etiology—Anatomy—Pathophysiology)
classication system (according to [24]). Clinical classications (C)
C class Description
C0 No visible or palpable signs of venous disease
C1 Teleangiectasias or reticular veins
C2 Varicose veins
C2r Recurrent varicose veins
C3 Edema
C4 Changes in skin and subcutaneous tissue secondary to chronic venous disease
C4a Pigmentation or eczema
C4b Lipodermatosclerosis or atrophie blanche
C4c Corona phlebectatica
C5 Healed
C6 Active venous ulcer
C6r Recurrent active venous ulcer
18 Chronic Venous Disease andVaricose Veins
Table 18.2 2020 update of
the CEAP (Clinical–
Etiology– AnatomyPathophysiology)
classication system
(according to [24]). Summary
of etiologic (E), anatomic
(A), and pathophysiologic (P)
classication
Grade Description
E class
Ep Primary
Es Secondary
Esi Secondary—intravenous
Ese Secondary—extravenous
Ec Congenital
En No cause identied
A class
As Supercial
Ad Deep
Ap Perforator
An No venous anatomic location identied
P class
Pr Reux
Po Obstruction
Pr, o Reux and obstruction
Pn No pathophysiology identied
Recommendation 3
For diagnosis and treatment planning in patients with suspected or clinically evident
chronic venous disease, full lower limb venous duplex ultrasound is recommended
as the primary imaging modality (Recommendation class I/Level of evidence B).
18.1 Guideline Recommendations
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385
Recommendation 4
For patients with suspected supra-inguinal venous obstruction, in addition to full leg
duplex assessment, ultrasound of the abdominal and pelvic veins should be considered, as part of the initial assessment. (Recommendation class IIa / Level of evidence C).
Recommendation 5
When an intervention is contemplated in patients with suspected supra-inguinal
venous obstruction, cross sectional imaging by magnetic resonance venography or
computed tomography is recommended in addition to duplex ultrasound assessment. (Recommendation class I/Level of evidence C).
18.1.1.2 Conservative Management
Recommendation 9
For patients with symptomatic chronic venous disease, elastic compression stockings, exerting a pressure of at least 15mmHg at the ankle, are recommended to
reduce venous symptoms. (Recommendation class I/Level of evidence B).
Recommendation 10
For patients with chronic venous disease and oedema (CEAP clinical class 3), compression treatment, using below knee elastic compression stockings, inelastic bandages or adjustable compression garments, exerting a pressure of 20–40mmHg at
the ankle, is recommended to reduce oedema. (Recommendation class I/Level of
evidence B).
Recommendation 11
For patients with chronic venous disease and lipodermatosclerosis and/or atrophie
blanche (CEAP clinical class C4b), using below knee elastic compression stockings, exerting a pressure of 20–40mmHg at the ankle, is recommended to reduce
skin induration. (Recommendation class I/Level of evidence B).
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18 Chronic Venous Disease andVaricose Veins
Recommendation 12
For patients with post-thrombotic syndrome, below knee elastic compression stockings, exerting a pressure of 20–40mmHg at the ankle, should be considered to
reduce severity. (Recommendation class IIa/Level of evidence B).
Note
Contraindications to compression treatment (according to [1]):
– Severe lower extremity atherosclerotic disease with ABI < 0.6 and/or ankle
pressure<60mmHg
– Extra-anatomic or supercially tunnelled arterial bypass at the site of intended
compression
– Severe heart failure, NYHA Class IV
– Heart failure NYHA Class III and routine application of compression devices
without clinical and haemodynamic monitoring
– Conrmed allergy to compression material
– Severe diabetic neuropathy with sensory loss or microangiopathy with the risk of
skin necrosis
NYHA Class IV: fatigue, palpitations, dyspnoea and/or angina at rest; NYHA Class
III: ordinary physical activity causes undue fatigue, palpitations, dyspnoea and/or
angina—comfortable at rest.
Recommendation 13
For patients with post-thrombotic syndrome, adjuvant intermittent pneumatic compression may be considered to reduce its severity. (Recommendation class IIb /
Level of evidence B).
Recommendation 14
For patients with symptomatic chronic venous disease, who are not undergoing
interventional treatment, are awaiting intervention, or have persisting symptoms
and/or oedema after intervention, medical treatment with venoactive drugs should
be considered to reduce venous symptoms and oedema, based on the available evidence for each individual drug. (Recommendation class IIa/Level of evidence A).
18.1.1.3 Interventions forSupercial Venous Incompetence
Recommendation 15
For patients with supercial venous incompetence presenting with symptomatic
varicose veins (CEAP clinical class C2S), interventional treatment is recommended.
(Recommendation class I/Level of evidence B).
18.1 Guideline Recommendations
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387
Recommendation 17
For patients with supercial venous incompetence, presenting with skin changes as
a result of chronic venous disease (CEAP clinical class C4- C6), interventional
treatment of venous incompetence is recommended. (Recommendation class I/
Level of evidence C).
Recommendation 18
For patients with supercial venous incompetence, undergoing treatment using
endovenous techniques with or without phlebectomies, the procedures should be
performed in the outpatient setting where possible. (Recommendation class I/Level
of evidence C).
Recommendation 19
For patients with supercial venous incompetence treated by endovenous thermal
ablation, ultrasound guided tumescent anaesthesia is recommended.
(Recommendation class I/Level of evidence C).
Recommendation 20
For patients with supercial venous incompetence treated under tumescent anaesthesia, buffered solutions should be considered to reduce peri-procedural pain.
(Recommendation class IIa/Level of evidence B).
Recommendation 21
For patients with supercial venous incompetence undergoing high ligation/stripping (HL/S), ultrasound guided tumescent anaesthesia may be considered, as an
alternative to general or regional anaesthesia. (Recommendation class IIb / Level of
evidence C).
18.1.1.4 Compression after Treatment/Thrombosis Prophylaxis
Recommendation 22
For patients with supercial venous incompetence undergoing ultrasound guided
foam sclerotherapy (UGFS) or endovenous thermal ablation of a saphenous trunk,
postprocedural compression treatment should be considered. (Recommendation
class IIa/Level of evidence A).
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18 Chronic Venous Disease andVaricose Veins
Recommendation 23
For patients with supercial venous incompetence undergoing stripping and/or
extensive phlebectomies, immediate postprocedural compression treatment is recommended. (Recommendation class I/Level of evidence A).
Recommendation 26
For patients with supercial venous incompetence undergoing intervention, individualised thromboprophylaxis strategies should be considered. (Recommendation
class IIa/Level of evidence B).
18.1.1.5 Techniques forSaphenous Ablation
Recommendation 28
For patients with great saphenous vein incompetence requiring treatment, endovenous thermal ablation is recommended as rst choice treatment, in preference to
high ligation/stripping and ultrasound guided foam sclerotherapy. (Recommendation
class I/Level of evidence A).
Recommendation 29
For patients with saphenous trunk incompetence undergoing thermal ablation, the
selection of the device should be left to the discretion of the treating physician.
(Recommendation class I/Level of evidence B).
Recommendation 30
For patients with great saphenous vein incompetence requiring treatment, cyanoacrylate adhesive closure should be considered when a non-thermal non-tumescent
technique is preferred. (Recommendation class IIa/Level of evidence A).
Recommendation 31
For patients with saphenous trunk incompetence undergoing treatment, ultrasound
guided foam sclerotherapy may be considered for treating saphenous trunks with a
diameter less than 6mm. (Recommendation class IIb/Level of evidence B).
18.1 Guideline Recommendations
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389
Recommendation 32
For patients with supercial venous incompetence treated with foam sclerotherapy,
the procedure should be performed under ultrasound guidance. (Recommendation
class I/Level of evidence C).
Recommendation 33
For patients with great saphenous vein incompetence requiring treatment, catheter
directed foam sclerotherapy with or without the use of peri-venous tumescent solution may be considered. (Recommendation class IIb/Level of evidence B).
Recommendation 34
For patients with great saphenous vein incompetence requiring treatment, mechanochemical ablation may be considered when a non-thermal non-tumescent technique
is preferred. (Recommendation class IIb/Level of evidence A).
Recommendation 35
For patients with great saphenous vein incompetence requiring treatment, high ligation/stripping should be considered, if endovenous thermal ablation options are not
available. (Recommendation class IIa/Level of evidence A).
Recommendation 36
For patients with chronic venous disease requiring treatment of varicose tributaries,
ambulatory phlebectomy, ultrasound guided foam sclerotherapy or a combination
of both are recommended. (Recommendation class I/Level of evidence B).
Recommendation 37
For patients with chronic venous disease requiring treatment of incompetent perforating veins, endovenous ablation, division or ligation should be considered.
(Recommendation class IIa/Level of evidence C).
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18 Chronic Venous Disease andVaricose Veins
Recommendation 40
For patients with reticular veins, where treatment is planned, sclerotherapy is recommended, as the rst choice treatment. (Recommendation class I/Level of evidence A).
Recommendation 41
For patients with telangiectasias, where treatment is planned, sclerotherapy should
be considered. (Recommendation class IIa/Level of evidence A).
Recommendation 42
For patients with telangiectasias, where treatment is planned, transcutaneous laser
should be considered. (Recommendation class IIa/Level of evidence B).
Recommendation 43
For patients with small saphenous vein incompetence requiring treatment, endovenous thermal ablation is recommended in preference to surgery or foam sclerotherapy. (Recommendation class I/Level of evidence A).
Recommendation 44
For patients with small saphenous vein incompetence requiring treatment, endovenous non-thermal non-tumescent ablation methods may be considered.
(Recommendation class IIb/Level of evidence B).
Recommendation 45
For patients with small saphenous vein incompetence treated by endovenous thermal ablation, care should be taken to avoid injury to the sural nerve if cannulation is
carried out below midcalf level. (Recommendation class I/Level of evidence B).
Recommendation 55
For patients with symptomatic recurrent varicose veins due to saphenous trunk
incompetence, endovenous thermal ablation or ultrasound guided foam sclerotherapy with or without phlebectomy should be considered. (Recommendation class
IIa/Level of evidence B).
18.2 Results
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Table 18.3 Summary of techniques available for treating saphenous trunk incompetence
(according to [1])
Published
Technique
EVTA ≥5years +++ +++ Yes
HLS ≥5years +++ +++ Yes, or alternative
CAC 3–5years +++ +++ No
UGFS ≥5years +/++ ++/+++ No
CDFS 1year ++ ++ Yes/no
MOCA 3years ++ +++ No
EVTA Endovenous thermal ablation, HLS High ligation and stripping, CAC Cyanoacrylate adhe-
sive closure, UGFS Ultrasound guided foam sclerotherapy, CDFS Catheter directed foam sclerotherapy, MOCA Mechanochemical ablation
+++ very good effect
++ good effect
+ some effect
follow-up
Reux
abolition
Quality of life
improvement Tumescence needed
anaesthesia technique
391
Recommendation 56
For patients with symptomatic recurrent varicose veins requiring treatment, where
endovenous ablation is possible, re-exploration of the groin or popliteal fossa is not
recommended. (Recommendation class III/Level of evidence B).
Recommendation 57
For patients with symptomatic recurrent varicose veins without truncal incompetence, ultrasound guided foam sclerotherapy and/or ambulatory phlebectomy should
be considered. (Recommendation class IIa/Level of evidence C).
Note
A summary of the techniques available for treating saphenous trunk incompetence
is given in Table18.3.
18.2 Results
18.2.1 Meta-Analyses
18.2.1.1 Interventions forGreat Saphenous Vein Incompetence
A Cochrane review [2] assessed the effects of endovenous laser ablation (EVLA),
radiofrequency ablation (RFA), endovenous steam ablation (EVSA), ultrasoundguided foam sclerotherapy (UGFS), cyanoacrylate glue, mechanochemical ablation
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