Aziz Faisal, Raffetto Joseph D, Diaz Jose A, Myers Daniel D, Ozsvath Kathleen J, Carman Teresa L, Lal Brajesh K
1 Vascular Surgery, Penn State Heart and Vascular Institute, Penn State Hershey College of Medicine, Hershey, PA, USA.
2 Vascular Surgery, VA Boston HCS, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Phlebology. 2017 Feb;32(1):19-26. doi: 10.1177/0268355515625526. Epub 2016 Jul 9.
Objectives Venous leg ulcers (VLU) are the most severe clinical sequelae of venous reflux and post thrombotic syndrome. There is a consensus that ablation of refluxing vein segments and treatment of significant venous obstruction can heal VLUs. However, there is wide disparity in the use and choice of adjunctive therapies for VLUs. The purpose of this study was to assess these practice patterns among members of the American Venous Forum. Methods The AVF Research Committee conducted an online survey of its own members, which consisted of 16 questions designed to determine the specialty of physicians, location of treatment, treatment practices and reimbursement for treatment of VLUs Results The survey was distributed to 667 practitioners and a response rate of 18.6% was achieved. A majority of respondents (49.5%) were vascular specialists and the remaining were podiatrists, dermatologists, primary care doctors and others. It was found that 85.5% were from within the USA, while physicians from 14 other countries also responded. Most of the physicians (45%) provided adjunctive therapy at a private office setting and 58% treated less than 5 VLU patients per week. All respondents used some form of compression therapy as the primary mode of treatment for VLU. Multilayer compression therapy was the most common form of adjunctive therapy used (58.8%) and over 90% of physicians started additional modalities (biologics, negative pressure, hyperbaric oxygen and others) when VLUs failed compression therapy, with a majority (65%) waiting less than three months to start them. Medicare was the most common source of reimbursement (52.4%). Conclusions Physicians from multiple specialties treat VLU. While most physicians use compression therapy, there is wide variation in the selection and point of initiation for additional therapies once compression fails. There is a need for high-quality data to help establish guidelines for adjunctive treatment of VLUs and to disseminate them to physicians across multiple specialties to ensure standardized high-quality treatment of patients with VLUs.
目标 下肢静脉溃疡（VLU）是静脉反流和血栓形成后综合征最严重的临床后果。人们一致认为，消融反流静脉段和治疗严重的静脉阻塞可以治愈VLU。然而，VLU辅助治疗的使用和选择存在很大差异。本研究的目的是评估美国静脉论坛成员的这些实践模式。方法 AVF研究委员会对其成员进行了一项在线调查，该调查由16个问题组成，旨在确定医生的专业、治疗地点、治疗实践以及VLU治疗的报销情况。结果 该调查共发放给667名从业者，回复率为18.6%。大多数受访者（49.5%）是血管专科医生，其余为足病医生、皮肤科医生、初级保健医生等。发现85.5%来自美国境内，同时还有来自其他14个国家的医生回复。大多数医生（45%）在私人诊所提供辅助治疗，58%的医生每周治疗少于5例VLU患者。所有受访者都使用某种形式的压迫疗法作为VLU的主要治疗方式。多层压迫疗法是最常用的辅助治疗形式（58.8%），超过90%的医生在VLU压迫治疗失败时开始采用其他治疗方式（生物制剂、负压、高压氧等），大多数（65%）等待不到三个月就开始使用。医疗保险是最常见的报销来源（52.4%）。结论 多个专科的医生都治疗VLU。虽然大多数医生使用压迫疗法，但一旦压迫失败，额外治疗的选择和开始时机存在很大差异。需要高质量的数据来帮助制定VLU辅助治疗的指南，并将其传播给多个专科的医生，以确保对VLU患者进行标准化的高质量治疗。
