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REFERATE GENERALE

GENERAL REPORTS

ACTUALIZAREA GHIDULUI NAIONAL DE BOAL


VENOAS CRONIC

UPDATING CHRONIC VENOUS DISEASE NATIONAL


GUIDELINE
CLIN GIURCNEANU*, ALEXANDRU TTARU**, MARIA ROTARU***,
LAURA GHEUC SOLOVSTRU****, CTLIN POPESCU*****,
MARIA MAGDALENA CONSTANTIN*****, IRINEL NEDELCU*****, ALIN NICOLESCU******

Rezumat Summary
Boala venoas cronic este o afeciune produs de Chronic venous disease is a condition that occurs when
alterarea funciei valvulelor venoase, att n sistemul venos the function of venous valves, both in the low-pressure,
superficial, de joas presiune, ct i n sistemul venos superficial venous system and the high-pressure, deep
profund, de presiune nalt al membrelor inferioare. venous system in lower extremities, is altered.
Netratat, boala venoas cronic are o evoluie Left untreated, chronic venous disease has a
progresiv, puin reversibil, realiznd alterri importante progressive, little reversible evolution, causing significant
ale calitii vieii pacientului, ajungndu-se, n ultimele alterations of the patients quality of life and developing
stadii, la invaliditate. Hemoragia, tromboflebita, infecia i disability when the condition reaches advanced stages.
Haemorrhage, thrombophlebitis, infection and pulmonary
trombembolismul pulmonar complic frecvent ultimele
embolism are common complications in the advanced stages
stadii ale bolii venoase cronice.
of chronic venous disease.
n prezent, boala venoas cronic a membrelor
Currently, chronic venous disease in lower extremities
inferioare este o important problem de sntate public. is a major public healthcare problem. Estimates show that
Se apreciaz c ntre 2%-5% din populaia statelor about 2%-5% of the population in developed countries have
industrializate prezint diverse grade de boal venoas a different stages of chronic venous disease of lower
membrelor inferioare, refluxul venos fiind mecanismul extremities, venous reflux being the physiopathological
fiziopatologic ntlnit n 30%-40% din aceste cazuri. mechanism incriminated in 30%-40% of these cases.
Simptomatologia extrem de divers a bolii venoase Highly diverse symptoms of chronic venous disease are
cronice apare progresiv pe o lung perioad de timp i experienced progressively, during a long period of time, and
necesit o adaptare permanent a terapeuticii, care trebuie require an ongoing adjustment of therapy that should
s rspund caracteristicilor clinice i fiziopatologice ale answer to clinical and physiopathological characteristics of
fiecrei etape de evoluie a bolii. each stage of chronic venous disease.
We submit a therapy guideline for chronic venous
disease of lower extremities, based on the personal clinical

* Spitalul Universitar de Urgen Elias, Bucureti.


** Clinica Dermatologie, Cluj-Napoca.
*** Clinica Dermatologie, Sibiu.
**** Clinica Dermatologie, Spitalul Sf. Spiridon Iai.
***** Spitalul Clinic Colentina, Bucureti.
****** CMDT Roma, Bucureti.

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Prezentm un ghid terapeutic al bolii venoase cronice experience of the authors, in compliance with the
a membrelor inferioare, rezultat din experiena clinic international clinical experience and with current therapy
personal a autorilor, n concordan cu experiena clinic guidelines available worldwide.
internaional i cu ghidurile terapeutice existente n Key words: chronic venous disease, treatment,
prezent la nivel mondial. guidelines.
Cuvinte cheie: boala venoas cronic, tratament, ghid.
Intrat n redacie: 26.08.2015 Received: 26.08.2015
Acceptat: 22.09.2015 Accepted: 22.09.2015

n urma modificrilor aduse terminologiei Following the amendments performed on the


bolii venoase cronice i a noii clasificri CEAP, terminology of chronic venous disease and the
precum i apariiei unor tehnici chirurgicale new CEAP classification, as well as following the
revoluionare (ablaie endovenoas, laser terapie, development of ground-breaking surgical
etc), dar i ca urmare a actualizrii ghidurilor techniques (endovenous ablation, laser therapy,
internaionale de practic pe seama studiilor etc.), as well as following the update of
recent publicate incluznd soluii farmacologice international practice guidelines based on
inovatoare pentru respectiva patologie (formulri recently published studies, including innovative
farmaceutice moderne precum fraciunea pharmacological solutions for the specific
flavonoidic purificat micronizat, dar i pathology (modern pharmaceutical formulas
produse biologice originale menite s amelioreze such as micronized purified flavonoid fraction, as
hemodinamica i s refac structurile vasculare well as original biological products intended to
deteriorate ca urmare a aciunilor lor vasculo- improve hemodynamics and to restore vascular
trope i antitrombotice, precum sulodexidul structures due to their vasculotropic and
original), Societatea Romn de Dermatologie, antithrombotic actions, such as original
prin colegiul su tiinific, a hotrt revizuirea i sulodexide), the Romanian Society of
actualizarea ghidului romnesc de boal venoas Dermatology, through its scientific college, has
cronic datnd din anul 2010 (OMS 1218, decided to review and update the Romanian
anexa 17). Guideline of Chronic Venous Disease as of 2010
Reprezentani de marc ai Colegiului tiin- (MoH Order 1218, anex 17).
ific al Societii Romne de Dermatologie (Prof. Renowned representatives of the Scientific
Dr. Clin Giurcneanu, Prof. Dr. Alexandru College of the Romanian Society of
Ttaru, Prof. Dr. Maria Rotaru, Prof. Dr. Laura Dermatology (Prof. Dr. Clin Giurcneanu, Prof.
Dr. Alexandru Ttaru, Prof. Dr. Maria Rotaru,
Gheuc Solovstru, Conf. Dr. Ctlin Popescu,
Prof. Dr. Laura Gheuc Solovstru, Assoc. Prof.
Dr. Alin Nicolescu i Dr. Irinel Nedelcu) adunai
Dr. Ctlin Popescu, Dr. Alin Nicolescu and Dr.
s analizeze temeinic referinele bibliografice
Irinel Nedelcu) gathered to thoroughly analyse
relevante publicate ntre 2009 i 2015, n special
the relevant bibliographic references published
ghidurile actualizate europene i americane ale
between 2009 and 2015, mainly the updated
unor prestigioase societi medicale de profil, au European and US guidelines issued by
reuit n final s elaboreze forma revizuit i prestigious medical societies, have finally
actualizat a ghidului naional de boal venoas succeeded in drawing the reviewed and
cronic pe care o dm publicitii n prezentul updated form of the national guideline for
numr al Revistei Societii Romne de Dermato- chronic venous disease which we release in this
logie. issue of the Journal of the Romanian Society of
Odat cu revizuirea i actualizarea ghidului Dermatology.
romnesc de boal venoas cronic, Societatea Pursuant to the review and update of the
Romn de Dermatologie se va alinia principiilor Romanian Guideline for Chronic Venous Disease,
de diagnostic i tratament ale acestei boli care the Romanian Society of Dermatology shall align
sunt folosite n prezent att la nivel european, ct to the principles for diagnosis and treatment of
i pe teritoriul Statelor Unite ale Americii. Astfel, this disease currently used both at European level

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se vor deschide medicilor dermatologi romni (i and in the US. Thus, new horizons shall open for
nu numai!) noi orizonturi de colaborare cu alte Romanian dermatologists (and not only!)
societi de profil europene i americane folosind regarding the collaboration with other European
o terminologie comun pentru diagnosticul i and US societies in the field, using a common
tratamentul acestei patologii, ceea ce n final e terminology for the diagnosis and treatment of
numai spre binele pacienilor. this disorder, which in the end only benefits to
patients.
BOALA VENOAS CRONIC
A MEMBRELOR INFERIOARE CHRONIC VENOUS DISEASE
OF LOWER EXTREMITIES NATIONAL
GHID NAIONAL DE TRATAMENT GUIDELINE OF TREATMENT
Definiie Definition and epidemiology
Boala Venoas Cronic (BVC) este caracte- Chronic Venous Disease is characterised by
rizat de simptome i semne instalate ca rezultat symptoms and signs occurring as a result of
al alterrilor structurale i funcionale ale venelor. structural and functional alterations of veins. The
Termenul de ,,Boal Venoas Cronic include term Chronic Venous Disease (CVD) includes
toate stadiile de boal conform clasificrii CEAP all disease stages according to CEAP
(clinic, etiologic, anatomic i patologic), dia- classification (clinical, etiological, anatomical and
gnosticul precis fiind pus pe seama simptomelor patho-physiological), as the accurate diagnosis is
i a semnelor clinice mpreun cu examenul established based on clinical symptoms and
doppler venos. signs, along with the Doppler venous exam.
Simptomele caracteristice sunt senzaia de Specific symptoms include heavy leg
picior greu, senzaia de picior obosit, crampele sensation, tired leg sensation, predominantly
predominant nocturne, durerea, pruritul, sen- nocturnal cramps, pain, pruritus, burn sensation
zaia de arsur sau senzaia de picior umflat. or swollen foot sensation.
Semnele includ telangiectazii, vene reticulare, Signs include telangiectasias, reticular veins,
vene varicoase, edemul, modificrile trofice cuta- varicose veins, oedema, trophic cutaneous
nate cum ar fi lipodermatoscleroza, dermatita, changes such as lipodermatosclerosis, dermatitis,
pigmentation and, in final development stages,
pigmentarea i, n stadiile evolutive finale, ulce-
ulcers. The term of chronic venous insufficiency
raia. Termenul de Insuficien Venoas Cronic
(CVI) is reserved to severe stages of chronic
(IVC) este rezervat stadiilor severe de Boal
venous disease (C3-C6) accompanied by severe
Venoas Cronic (C3-C6) nsoite de leziuni
morphological and functional lesions, with
morfologice i funcionale severe cu alterarea
significant alteration of the quality of life.
semnificativ a calitii vieii.

Epidemiologie Epidemiology

La nivel mondial 10-33% din femeile adulte i Globally, 10-33% of adult women and 10-20%
10-20% din brbai au Boal Venoas Cronic. n of men have chronic venous disease. In European
statele europene prevalena este chiar mai mare countries, prevalence is even higher than 20-50%,
de 20 pn la 50%, ultimele date ajungnd chiar the last data reaching even 85%.
la procente de pn la 85%. In Romania, recent epidemiological studies
n Romnia studii epidemiologice recente cu with national relevance have shown a CVD
relevan naional au artat o prevalen a BVC prevalence of 32%.
de 32%.
Treatment
Tratament
The treatment of chronic venous disease is
Tratamentul bolii venoase cronice este com- complex, is performed according with the stage
plex, se face n funcie de stadiul bolii i include: of the disease and includes: hygiene and diet,

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regimul igieno-dietetic, terapia medicamentoas drug therapy (systemic or local), compressive


(sistemic sau local), terapia compresiv, terapia therapy, local therapy of venous ulcer,
local a ulcerului venos, scleroterapia, terapia sclerotherapy, endovenous therapy (vapours,
endovenoas (vapori, laser endovenos, radio- endovenous laser, radiofrequency, etc.), surgical
frecven, etc), tratamentul chirurgical i terapia treatment and vascular laser therapy.
cu laser vascular. The treatment of chronic venous disease is
Tratamentul bolii venoase cronice se stabi- determined according to the stage of the disease,
lete funcie de stadiul bolii, dup protocolul de after the protocol below, as treatment can be
mai jos, tratamentul sistemic putnd fi iniiat initiated including by the family doctor.
inclusiv de ctre medicul de familie.
0. Patients with Chronic Venous Disease
0. Pacieni cu Boal Venoas Cronic n in CEAP COs stage
stadiul CEAP COs Description of the stage according to the
Descrierea stadiului conform clasificrii reviewed CEAP classification:
- patients without visible and palpable signs
CEAP revizuite:
of Chronic Venous Disease, but with
pacieni fr semne palpabile sau vizibile
characteristic symptoms: pain, heavy foot
de Boal Venoas Cronic, dar cu simptome
sensation, swollen foot sensation, muscle
caracteristice: durere, senzaie de picior
cramps, pruritus, skin rashes and any
greu, senzaie de picior umflat, crampe
other symptoms attributable to the
musculare, prurit, iritaii cutanate i oricare
Chronic Venous Disease.
alte simptome atribuibile Bolii Venoase
Cronice. Therapy methods:
- lifestyle changes;
Modaliti terapeutice:
- identification and removal/treatment of
schimbarea stilului de via;
aggravating factors and/or comorbidities;
identificarea i nlturarea/tratarea facto-
- systemic treatment:
rilor favorizani i/sau a comorbiditilor;
diosmin (450 mg) hesperidin (50 mg),
tratament sistemic: 2 tablets daily;
diosmin (450 mg) hesperidin (50 sulodexide 2 capsules x 250 LSU daily (1
mg), 2 tablete zilnic; capsule x 250 LSU, 2 times per day),
sulodexid 2 capsule a 250 ULS pe zi (1 between the main meals, chronic
capsul a 250 ULS de 2 ori pe zi), ntre treatment;
mesele principale, tratament cronic; procyanidolic oligomers;
oligomeri procianidolici; other phlebotonics;
alte flebotonice; - elastic contention depending on each case.
contenie elastic n funcie de fiecare caz
n parte. 1. Patients with Chronic Venous Disease
in CEAP C1 stage
1. Pacieni cu Boal Venoas Cronic n Description of the stage according to the
stadiul CEAP C1 reviewed CEAP classification:
Descrierea stadiului conform clasificrii patients with telangiectasias (conflated
CEAP revizuite: and dilated intradermal venules with a
diameter below 1 mm) or reticular veins
pacieni cu telangiectazii (venule intra-
(dilated subdermal veins, with a diameter
dermice confluate i dilatate cu diametrul
between 1 and 3 mm, tortuous).
mai mic de 1 mm) sau vene reticulare (vene
subdermice dilatate, cu diametrul ntre 1 i Therapy methods:
3 mm, tortuoase). lifestyle changes;

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Modaliti terapeutice: identification and removal/treatment of


schimbarea stilului de via; aggravating factors and/or comorbidities;
identificarea i nlturarea/tratarea facto- systemic treatment:
rilor favorizani i/sau a comorbiditilor; diosmin (450 mg) hesperidin (50 mg),
tratament sistemic: 2 tablets daily;
diosmin (450 mg) hesperidin (50 sulodexide 2 capsules x 250 LSU daily (1
mg), 2 tablete zilnic; capsule x 250 LSU, 2 times per day),
sulodexid 2 capsule a 250 ULS pe zi (1 between the main meals, chronic
capsul a 250 ULS de 2 ori pe zi), ntre treatment;
mesele principale, tratament cronic; procyanidolic oligomers;
oligomeri procianidolici; other phlebotonics;
alte flebotonice; elastic contention depending on each case;
contenie elastic n funcie de fiecare caz
sclerotherapy;
n parte;
vascular laser (PDL, ND:YAG, diode, etc).
scleroterapie;
laser vascular (PDL, Nd:YAG, diod, etc.).
2. Patients with Chronic Venous Disease
in CEAP C2 stage
2. Pacieni cu Boal Venoas Cronic n
stadiul CEAP C2 Description of patients according to the
reviewed CEAP classification:
Descrierea pacienilor conform clasificrii
patients with varicose veins -
CEAP revizuite:
subcutaneous venous dilations, with a
pacieni cu vene varicoase dilataii
venoase subcutanate mai mari de 3 mm diameter above 3 mm while standing.
diametru n ortostatism. Acestea pot s These could involve the saphenous vein,
implice vena safen, venele tributare the tributaries of the saphenous vein or the
safenei sau venele nonsafeniene. Au cel non-saphenous vein. Most frequently they
mai frecvent un aspect tortuos. have a tortuous appearance.
Modaliti terapeutice: Therapy methods:
schimbarea stilului de via; lifestyle changes;
identificarea i nlturarea/tratarea fact- identification and removal/treatment of
orilor favorizani i/sau a comorbidi- aggravating factors and/or comorbidities;
tilor; systemic treatment:
tratament sistemic: sulodexide 2 capsules x 250 LSU daily (1
sulodexid 2 capsule a 250 ULS pe zi (1 capsule x 250 LSU, 2 times per day),
capsul a 250 ULS de 2 ori pe zi), ntre between the main meals, chronic
mesele principale, tratament cronic; treatment;
diosmin (450 mg) hesperidin (50
diosmin (450 mg) hesperidin (50 mg),
mg), 2 tablete zilnic;
2 tablets daily;
oligomeri procianidolici;
procyanidolic oligomers;
alte flebotonice;
other phlebotonics;
contenie elastic n funcie de fiecare caz
n parte; elastic contention depending on each case;
scleroterapie; sclerotherapy;
laser vascular (PDL, Nd:YAG, diod, etc.); vascular laser (PDL, Nd:YAG, diode, etc.);
terapie endovenoas; endovenous therapy;
tratament chirurgical *. surgical treatment*.

* Tehnica va fi selectat n funcie de fiecare caz n parte * The technique shall be selected depending on each case
i n funcie de dotarea i experiena centrului medical. and on the endowment and experience of the medical centre.

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3. Pacieni cu Boal Venoas Cronic n 3. Patients with Chronic Venous Disease


stadiul CEAP C3 in CEAP C3 stage
Descrierea pacientului n conformitate cu Description of patient according to the
clasificarea CEAP revizuit: reviewed CEAP classification:
pacieni cu edeme definite ca i creterea patients with oedema - defined as
perceptibil a volumului de fluide la nive- perceivable increase of the volume of
lul pielii i esutului celular subcutanat, fluids at the skin and subcutaneous cell
evideniabil clinic prin semnul godeului. tissue level, clinically distinguishable
De cele mai multe ori edemul apare n through the well sign. Most of the time, the
regiunea gleznei, dar se poate extinde la oedema occurs in the ankle region, but can
picior i, ulterior, la nivelul ntregului also extend to the leg and, further, to the
membru inferior. entire lower extremity.
Modaliti terapeutice: Therapy methods:
schimbarea stilului de via; lifestyle changes;
identificarea i nlturarea/tratarea facto- identification and removal/treatment of
rilor favorizani i/sau a comorbiditilor; aggravating factors and/or comorbidities;
tratament sistemic: systemic treatment:
sulodexid 4 capsule a 250 ULS pe zi (2 sulodexide 4 capsules x 250 LSU daily
capsule a 250 ULS de 2 ori pe zi, ntre (2 capsules x 250 LSU, 2 times per day),
mesele principale), pn la dispariia between the main meals, until the
clinic a edemului, apoi 2 capsule a 250 clinical cure of oedema, followed by 2
ULS pe zi (1 capsul a 250 ULS de 2 ori capsules x 250 LSU daily (1 capsule x
pe zi), ntre mesele principale, tratament 250 LSU, 2 times per day) between the
cronic;
main meals, chronic treatment;
diosmin (450 mg) hesperidin (50
diosmin (450 mg) hesperidin (50 mg),
mg), 2 tablete zilnic;
2 tablets daily;
oligomeri procianidolici;
procyanidolic oligomers;
alte flebotonice;
other phlebotonics;
contenie elastic - n funcie de fiecare caz
elastic contention depending on each case;
n parte.
scleroterapie; sclerotherapy;
laser vascular (PDL, Nd:YAG, diod, etc.); vascular laser, diode, etc.;
terapie endovenoas; endovenous therapy;
tratament chirurgical *. surgical treatment*.

4. Pacieni cu Boal Venoas Cronic n 4. Patients with Chronic Venous Disease


stadiul CEAP C4 in CEAP C4 stage
Descrierea pacientului conform clasificrii Description of the patient according to the
CEAP revizuite: reviewed CEAP classification:
C4a pacieni care prezint: C4a - patients with:
pigmentaia - colorarea brun nchis a pielii pigmentation - dark brown colouring of
datorit extravazrii hematiilor. Apare cel the skin as a result of erythrocyte
mai frecvent n regiunea gleznei, dar se extravasation. Most frequently occurs in
poate extinde ctre picior, gamb i ulterior the ankle area, but can also extend to the
coaps. foot, leg and further to the thigh.

* Tehnica va fi selectat n funcie de fiecare caz n parte * The technique shall be selected depending on each case
i n funcie de dotarea i experiena centrului medical. and on the endowment and experience of the medical centre.

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Eczema: dermatita eritematoas care se Eczema: erythematous dermatitis that can


poate extinde la nivelul ntregului membru extend on the entire surface of the lower
inferior. De cele mai multe ori este loca- extremity. Most of the time, it is located
lizat n apropierea varicelor, dar poate near varicose veins, but it can occur
aprea oriunde la nivelul membrului anywhere on the lower extremity. It is most
inferior. Este cel mai frecvent consecina frequently the consequence of Chronic
Insuficienei Venoase Cronice, dar poate s Venous Insufficiency, but can also be
fie i secundar tratamentelor locale related to local treatments applied.
aplicate. C4b - patients with:
C4b pacieni care prezint: Lipodermatosclerosis: localised chronic
Lipodermatoscleroz: fibroz postinflama- post-inflammatory fibrosis of skin and
torie cronic localizat a pielii i esutului subcutaneous cell tissue, sometimes
celular subcutanat, asociat n unele cazuri associated with Achilles tendon
cu contractur a tendonului Ahilean. contracture. Sometimes it is preceded by
Uneori este precedat de edem inflamator diffuse, painful inflammatory oedema. In
difuz, dureros. n acest stadiu preteaz la this stage, a differential diagnosis of
diagnostic diferenial cu limfangita, erizi- lymphangitis, erysipelas or cellulitis is
pelul sau celulita. Este un semn al Insufi- considered. This is a sign of very advanced
cienei Venoase Cronice foarte avansate. Chronic Venous Insufficiency.
Atrofie alb: zone circumscrise de tegu- White atrophy: circumscribed atrophy
ment atrofic, uneori cu evoluie circum- tegument areas, sometimes with
ferenial, nconjurate de capilare dilatate circumferential progress, encircled by
i uneori de hiperpigmentare. dilated capillaries and sometimes by
hyperpigmentation.
Modaliti terapeutice:
schimbarea stilului de via; Therapy methods:
identificarea i nlturarea/tratarea facto- lifestyle changes;
rilor favorizani i/sau a comorbiditilor; identification and removal/treatment of
tratament sistemic: aggravating factors and/or comorbidities;
sulodexid 4 capsule a 250 ULS pe zi (2 systemic treatment:
capsule a 250 ULS de 2 ori pe zi, ntre sulodexide 4 capsules x 250 LSU daily (2
mesele principale), pn la dispariia capsules x 250 LSU, 2 times per day)
tulburrilor de troficitate cutanat, between the main meals), until all skin
apoi 2 capsule a 250 ULS pe zi (1 capsul trophicity disorders are cured, then 2
a 250 ULS de 2 ori pe zi), ntre mesele capsules x 250 LSU daily (1 capsule x
principale, tratament cronic; 250 LSU, 2 times per day), between the
diosmin (450 mg) hesperidin (50 main meals, chronic treatment;
mg), 2 tablete zilnic; diosmin (450 mg) hesperidin (50 mg),
oligomeri procianidolici; 2 tablets daily;
alte flebotonice; procyanidolic oligomers;
contenie elastic - n funcie de fiecare caz other phlebotonics;
n parte. elastic contention depending on each case;
scleroterapie; sclerotherapy;
laser vascular (PDL, Nd:YAG, diod, etc.); vascular laser, diode, etc.;
terapie endovenoas; endovenous therapy;
tratament chirurgical *. surgical treatment*.

* Tehnica va fi selectat n funcie de fiecare caz n parte * The technique shall be selected depending on each case
i n funcie de dotarea i experiena centrului medical. and on the endowment and experience of the medical centre.

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5. Pacieni cu Boal Venoas Cronic n 5. Patients with Chronic Venous Disease


stadiul CEAP C5, C6 in CEAP C5, C6 stages
Definirea tipului de pacient conform cu Defining the type of patient according to the
clasificarea CEAP revizuit: CEAP classification reviewed:
C5 - ulcer venos vindecat C5 - cured venous ulcer
C6 - ulcer venos activ - leziune ce afecteaz C6 - active venous ulcer - lesion entirely
tegumentul n totalitate, cu pierdere de substan
affecting the tegument, while the substance loss
care nu se vindec spontan. Apare cel mai
frecvent la nivelul gleznei. does not cure spontaneously. Most frequently it
occurs in the ankle area.
Modaliti terapeutice:
schimbarea stilului de via; Therapy methods:
identificarea i nlturarea/tratarea facto- lifestyle changes;
rilor favorizani i/sau a comorbiditilor; identification and removal/treatment of
tratament sistemic: aggravating factors and/or comorbidities;
sulodexid 1 fiol a 600 ULS pe zi (i.m systemic treatment:
sau i.v.) timp de 20-30 de zile, apoi 4 sulodexide 1 vial x 600 LSU daily for 20-
capsule a 250 ULS pe zi (2 capsule a 250 30 days, then 4 capsules x 250 LSU daily
ULS de 2 ori pe zi, ntre mesele prin- (2 capsules x 250 LSU, 2 times per day),
cipale) pn la vindecarea ulcerului between the main meals, until the ulcer
(C6), dup care 2 capsule a 250 ULS pe zi (C6) is cured (C5), followed by 2
(1 capsul a 250 ULS de 2 ori pe zi), ntre capsules x 250 LSU daily (1 capsule x
mesele principale, tratament cronic (C5); 250 LSU, 2 times per day), between the
diosmin (450 mg) hesperidin (50 main meals, chronic treatment;
mg), 2 tablete zilnic; diosmin (450 mg) hesperidin (50 mg);
oligomeri procianidolici; procyanidolic oligomers;
alte flebotonice; other phlebotonics;
contenie elastic - n funcie de fiecare caz elastic contention depending on each case;
n parte.
sclerotherapy;
scleroterapie;
vascular laser (PDL, Nd:YAG, diode, etc.);
laser vascular (PDL, Nd:YAG, diod, etc.);
endovenous therapy;
terapie endovenoas;
tratament chirurgical *; surgical treatment*.
tratament topic **/pansament coloidal; topical treatment**/hydrocolloid dressing;
tratament antibiotic sistemic ***. systemic antibiotic therapy***.

* Tehnica va fi selectat n funcie de fiecare caz n parte * The technique shall be selected depending on each case
i n funcie de dotarea i experiena centrului medical. and on the endowment and experience of the medical centre.
** Tratamentul topic va fi ales n concordan cu fiecare ** The topical treatment shall be selected for each case
caz n parte. individually.
*** Tratamentul antibiotic local este de evitat datorit *** Local antibiotic therapy should be avoided due to the
riscului de selectare a unei flore bacteriene rezistente sau risk of selecting a bacterial flora with resistance or
plurirezistente la antibiotice. Se recomand administrarea de multiresistance to antibiotics. It is recommended to give
antibiotice sistemice n prezena unor dovezi bacteriologice systemic antibiotics based on bacteriological evidence of
de infecie tisular cu streptococ beta-hemolitic. tissue infections with beta-haemolytic Streptococcus.

Bibliografie/Bibliography
1. Management of chronic venous disorders of the lower limbs Guidelines According to Scientific Evidence
(The European Venous Forum, The International Union of Angiology, The Cardiovascular Disease Educational and Research
Trust (UK), Union Internationale de Phlebologie. International Angiology, Ch. 18, April 2014)
2. Management of Chronic Venous Disorders of the Lower Limbs: Guidelines according to Scientific Evidence
(International Angiology, vol 27, febr. 2008)

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DermatoVenerol. (Buc.), 60: 187-195

3. Acute and chronic Venous Disease: current status and future directions (Journal of Vascular Surgery, vol 45, suppl 3,
December 2007)
4. The care of patients with varicose veins and associated chronic venous diseases: Clinical practice guidelines of the
Society for Vascular Surgery and the American Venous Forum (JOURNAL OF VASCULAR SURGERY, Volume 53,
Number 16S, Gloviczki et al, Copyright 2011 by the Society for Vascular Surgery. doi:10.1016/j.jvs.2011.01.079)
5. Antithrombotic Therapy for Venous Thrombo-embolic Disease: American College of Chest Physicians Evidence-
Based Clinical Practice Guidelines (8th Edition) (Clive Kearon, Susan R. Kahn, Giancarlo Agnelli, Samuel Goldhaber,
Gary E. Raskob and Anthony J. Comerota. Chest 2008;133;454-545DOI 10.1378/chest.08-0658)
6. Updated terminology of chronic venous disorders: The VEIN-TERM transatlantic interdisciplinary consensus
document (JOURNAL OF VASCULAR SURGERY, Feb. 2009, Volume 49, Number 2, Eklf et al)

Conflict de interese Conflict of interest


NEDECLARATE NONE DECLARED

Adresa de coresponden: Prof. Dr. Dumitru Alexandru Tataru


Clinica Dermatovenerologie Cluj-Napoca, Str Clinicilor 3-5
Email: dr.tataru@yahoo.com

Correspondance address: Prof. Dr. Dumitru Alexandru Tataru


Dermatovenereology Clinic Cluj Napoca, 3-5 Clinics
Email: dr.tataru@yahoo.com

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