Venous Insufficiency

本病例由北京世纪坛医院的魏德华教授提供，该患者为糖尿病足（wagner 1级）患者，经过清创术、常规血糖控制及护理，在使用一种外用中成药膏无明显效果的情况下，换用香雷糖足膏治疗后，足溃疡痊愈。 病例分享专家 魏德华 硕士研究生，医师 研究方向：糖尿病足，慢性创面治疗 单位：首都医科大学附属北京世纪坛医院 矫形外科（糖尿病足中心） 01 基本信息 患者，侯某，性别：男性，年龄：57岁 主诉 右足第5趾和右足跟破溃、渗液3个月余 现病史 患者于3个月前无明显诱因出现右足第5趾和右足跟破溃、渗液，后右足第5趾远端出现发黑，当时未重视，家中予碘伏换药治疗后症状无明显缓解，来我院急诊就诊，以“糖尿病性足坏疽，2型糖尿病足（wagner 1级）”收住院。 既往史 既往有2型糖尿病、高血压、高脂血症、冠心病病史10余年，具体用药不详，足部慢性顽固性疼痛，10年前行冠脉支架置入术，半年余前行双下肢动脉扩张成形术支架置入术，否认传染病史，否认外伤史，否认输血史，否认食物、药物过敏史。 体格检查 右足第5趾发黑，基底部挤压见少量黄褐色脓液流出，局部肿胀；右足跟外侧见大小约3cm*2cm创面，表面见脓性分泌物附着，深达真皮层，周围明显红肿，皮温高。右侧足背动脉、胫后动脉未扪及，趾端血运可，左侧足背动脉、胫后动脉搏动弱，左足皮温低，双小腿及足部感觉减退。 入院诊断 1. 2型糖尿病性周围血管病及坏疽 2. 2型糖尿病足（wagner 1级） 3. 2型糖尿病 4. 下肢动脉粥样硬化闭塞症 5. 冠状动脉粥样硬化性心脏病 6. 高血压病2级（极高危） 7. 冠状动脉支架植入术后 8. 慢性顽固性疼痛 治疗经过 常规血糖控制、营养支持、抗感染及护理基础上，进行足跟部创面局部清创，加用创口恢复药物治疗，在使用外用中成药膏治疗2天后，患者反馈伤口略微恶化，更换为香雷糖足膏治疗，每日一次，整个疗程使用量为三分之一支（约15g），约2周后，患者痊愈，未发现不良反应，患者反馈良好，予以出院。 左右滑动查看｜治疗前后状况 使用香雷糖足膏后溃疡面积随时间的变化 使用香雷糖足膏后溃疡面积随治疗周期的变化 02 专家分析1 糖尿病患者容易发生多种并发症，其中糖尿病足溃疡(DFU)是导致患者截肢和死亡的重要因素。Wagner分级是一种常用的糖尿病足病评估系统，用于评估糖尿病患者足部溃疡和糖尿病足部感染的严重程度。目前治疗DFU的常规方法包括局部清创引流、扩张血管、控制感染以及促进创面溃疡愈合，但创面保护、避免恶化及促进溃疡愈合仍是目前治疗的重难点1。 该患者为57岁男性，已有糖尿病史10年，因右足小趾和右足跟溃烂就诊，诊断为W1级糖尿病足。常规血糖控制及护理基础上，起初使用外用中成药膏，患者反馈不佳，创口未有明显改善，换用香雷糖足膏两周后痊愈，未发现不良反应。 香雷糖足膏成份为到手香提取物、积雪草总苷，研究2证实，到手香提取物通过阻断p65NF-κB激活来抑制脂多糖（LPS）诱导步骤，同时还抑制LPS诱导的细胞中ATP诱导的信号通路，包括对ACS二聚和寡聚、K+外排反应，以及半胱天冬酶-1、白细胞介素（IL）-1β和IL-18的释放反应的抑制。通过调节 M1/M2 巨噬细胞间的平衡达到治疗糖足溃疡效果。该病例中，整个治疗过程中患者反馈良好，临床评价较好。 03 专家分析2 糖尿病足致残、致死率高，治疗的医疗费用高，会造成沉重的家庭及社会负担3。而传统治疗在促进DFU伤口愈合方面的效果较差，DFU患者常病情反复、伤口迟延愈合，易导致截肢等不良后果4。 该病例为老年男性患者，糖尿病史为10年，因W1级糖尿病足入院，右足跟溃疡清创术后为开放伤口，治疗的难点在于患者病史较长且血糖控制欠佳，溃疡面恢复较慢，经一种外用药物治疗后无明显改善。 香雷糖足膏是1.1类天然药物，是DFU的一种难愈性创面突破性疗法，《糖尿病足溃疡创面治疗专家共识(2024)》5指出，香雷糖足膏通过抑制NOD样受体热蛋白结构域相关蛋白3（NLRP3）炎症小体与下游炎症因子［白细胞介素（IL）-6、肿瘤坏死因子（TNF）-α、IL-1β］表达，抑制M1型巨噬细胞极化，并活化脂肪祖细胞分泌粒细胞集落刺激因子(G-CSF) 与CXC基序趋化因子配体3（CXCL3），促进M2a / M2c型巨噬细胞极化，从而控制创面炎症并快速进入增生期，达到促进溃疡愈合的作用。在本病例中，患者右足跟处行清创术，在常规血糖控制及护理基础上，换用香雷糖足膏治疗显示出显著的疗效。当然，应注意的是，香雷糖足膏的使用频次按照说明书为每日两次。 04 专家简介 第一位点评专家  王江宁 教授 教授、博士生导师 首都医科大学博士研究生导师，辽宁中医药大学博士研究生导师，首都医科大学附属北京世纪坛医院矫形外科主任 首都医科大学附属北京世纪坛医院中西医结合糖尿病足治疗中心主任 首都医科大学(科技园)临床医学工程转化研究所所长 学术任职: 享受国务院特殊津贴（国务院特殊贡献专家）；          卫生部首批科普专家（全国骨科共十二位专家）；          世界国际医学保肢协会副主席；           世界国际医学保肢协会中国区主席；          中华预防医学会组织感染与损伤防治与控制专业委员会全国主任委员；          教育部及北京市科技进步奖行评专家；          国家自然科学基金评审专家；          北京市卫计委糖尿病足知名专家团队首席专家。 发表国家级医学核心期刊论文100余篇，以第一作者及通讯作者发表SCI收录文章60余篇。主编书籍6部，主译书籍2部，承担国家科技部重点研发计划2项，国家自然基金项目3项，首都临床特色应用研究与成果推广项目3项，拥有发明专利5项，实用新型专利10项。从医40余年，有二项手术填补国际空白，有二项科研成果填补国内空白，是中国治疗糖尿病足、褥疮难愈合创面及小儿麻痹后遗症、脑瘫后遗症畸形矫正的顶级专家。 第二位点评专家 王方明 教授 医学硕士，主任医师 解放军总医院工作20余年 曾经到武汉第三医院、积水潭医院整、北医三医院、宣武医院进修烧伤整形、显微外科、血管外科 从事烧伤整形、创面修复、周围血管外科临床一线工作30余年，积累了丰富临床经验，善于应用各种皮瓣修复复杂难愈合创面；善于进行外周血管的介入治疗，对糖尿病足的治疗具有丰富经验。 擅长主治： 1、糖尿病及并发双下肢麻木、疼痛、畏冷及糖尿病足等； 2、压疮（褥疮）。 3下肢静脉性溃疡（静脉曲张性溃疡）、脉管炎、下肢混合性溃疡（老烂腿）。 4、各种原因导致的慢性创面不愈合； 5、动脉性疾病：动脉硬化性闭塞症、糖尿病足、肾动脉狭窄、颈动脉狭窄、血栓闭塞性脉 管炎、急性动脉栓塞、多发性大动脉炎、皮肤血管炎、雷诺氏病(症)等； 6、静脉疾病：深静脉血栓形成、下肢静脉功能不全、静脉曲张、浅静脉炎等 参考文献 1、王艳,李岩岩,孙照阳.VSD技术联合rb-bFGF治疗Wagner2级糖尿病足溃疡的效果[J].临床医学,2024,44(07):39-41.DOI:10.19528/j.issn.1003-3548.2024.07.012. 2、Leu WJ, Chen JC, Guh JH. Extract From Plectranthus amboinicus Inhibit Maturation and Release of Interleukin 1β Through Inhibition of NF-κB Nuclear Translocation and NLRP3 Inflammasome Activation. Front Pharmacol. 2019 May 28;10:573. doi: 10.3389/fphar.2019.00573. PMID: 31191313; PMCID: PMC6546882. 3、中华医学会糖尿病学分会, 中华医学会感染病学分会, 中华医学会组织修复与再生分会. 中国糖尿病足防治指南(2019版)(I). 中华糖尿病杂志 2019, 11(2):92-108. 4、陈耀楠, 等. 糖尿病足溃疡慢性伤口的形成机制及新型敷料的研究进展 [J] . 中华糖尿病杂志, 2023, 15(2) : 199-203. 5、中华医学会内分泌学分会,中国内分泌代谢病专科联盟.糖尿病足溃疡创面治疗专家共识(2024)[J].中华内分泌代谢杂志, 2024, 40(07):565-569.DOI:10.3760/cma.j.cn311282-20240625-00281. 免责声明：本文仅作最新前沿信息交流之目的，文中所有观点不代表梅斯医学立场，亦不代表梅斯医学支持或反对文中观点。如需获得治疗方案指导，请前往正规医院就诊！

PHILADELPHIA, Oct. 15, 2024 /PRNewswire/ -- In honor of World Thrombosis Day, the National Blood Clot Alliance ("NBCA"), the nation's leading patient advocacy organization dedicated to advancing the prevention, early diagnosis, and treatment of venous blood clots, is proud to announce its endorsement of DEFIANCE, a prospective, multinational, randomized controlled trial ("RCT") from Inari Medical that aims to advance clinical research for patients suffering from Deep Vein Thrombosis ("DVT"). The DEFIANCE trial will evaluate and compare the clinical outcomes of certain symptomatic DVT patients following treatment with mechanical thrombectomy using Inari Medical's ClotTriever System to treatment with anticoagulation medication alone. "The vast majority of DVT survivors in the NBCA community were treated with the current standard of care, anticoagulation, and too many have developed the debilitating symptoms of post-thrombotic syndrome (PTS) with swollen legs, difficulty walking, skin changes and poorly healing open wounds," said NBCA President and Board Chair, Leslie Lake. "Mechanical thrombectomy procedures that remove clot using technologies like ClotTriever may reduce the risk of PTS in some DVT patients. NBCA commends Inari Medical for investing in DEFIANCE, a much-needed landmark trial which has the potential to impact future guidelines for patients." The DEFIANCE trial will enroll up to 300 patients at up to 60 global sites. The trial's primary endpoint will be a composite of: 1) treatment failure or therapy escalation rates, and 2) severity of PTS assessed at the 6-month follow-up. The study's rigorous design will ensure that the results contribute to a better understanding of how these therapies perform in real-world practice, potentially guiding future treatment protocols and care decisions for DVT patients. "Inari Medical is wholly committed to VTE patients and producing definitive evidence to support our technologies," said Dr. Thomas Tu, Inari's Chief Medical Officer. "We are honored to have DEFIANCE receive the endorsement of NBCA, the largest nationally recognized organization dedicated to supporting patients and families affected by blood clots through education, advocacy, and awareness. Our team is also grateful for the collaboration and dedication of our clinical trial investigators, who continually push the field forward in the name of better patient outcomes." About Inari Medical, Inc. Patients first. No small plans. Take care of each other. These are the guiding principles that form the ethos of Inari Medical. We are committed to improving lives in extraordinary ways by creating innovative solutions for both unmet and underrecognized health needs. In addition to our purpose-built products, we leverage our capabilities in education, clinical research, and program development to improve patient outcomes. We are passionate about our mission to establish our treatments as the standard of care for venous thromboembolism and beyond. We are just getting started. About the National Blood Clot Alliance The National Blood Clot Alliance (NBCA) is a 501(c)(3), non-profit, voluntary health organization dedicated to advancing the prevention, early diagnosis and successful treatment of life-threatening blood clots such as deep vein thrombosis and pulmonary embolism. NBCA works on behalf of people who may be susceptible to blood clots, including, but not limited to, people with clotting disorders, atrial fibrillation, cancer, traumatic injury, and risks related to surgery, lengthy immobility, childbirth and birth control. NBCA accomplishes its mission through programs that build public awareness, educate patients and healthcare professionals, and promote supportive public and private sector policy. Media Contact: Tarin Patrikis [email protected] (703) 935-8873 SOURCE National Blood Clot Alliance WANT YOUR COMPANY'S NEWS FEATURED ON PRNEWSWIRE.COM? 440k+ Newsrooms & Influencers 9k+ Digital Media Outlets 270k+ Journalists Opted In GET STARTED

PALM SPRINGS, Calif., Sept. 6, 2024 /PRNewswire/ -- Leading physicians and researchers will present results from 21 clinical trials from Sunday, November 3, to Tuesday, November 5, at the annual VIVA and The VEINS conferences at Wynn Las Vegas. VIVA (Vascular InterVentional Advances) is a vascular education symposium that emphasizes innovation and multidisciplinary learning. The 2024 conference will mark VIVA's 22nd anniversary as a premier educational event for peripheral vascular disease specialists. The VEINS (Venous Endovascular INterventional Strategies) is a comprehensive symposium focused on the diagnosis, intervention, and management of venous disorders. VIVA and The VEINS bring together an international, multispecialty faculty to provide a comprehensive learning experience featuring dynamic presentations and live cases, hands-on workshops, and in-depth expert discussion and debate. The conferences attract an audience of interventional cardiologists, interventional radiologists, vascular surgeons, and endovascular medicine specialists. To view the full schedule for both conferences, please visit . Clinical trial results to be presented: Listed in presentation order* The VEINS Clot Burden Reduction With a Novel Thrombectomy Device for the Treatment of Acute Pulmonary Embolism: RV/LV Ratio and MMS Reductions Observed in the Pilot ENGULF Trial Julie Bulman, MD Randomized Controlled Trial Comparing Cyanoacrylate Closure to Surgical Stripping: Spectrum Program Secondary Outcomes Through Six Months Manj Gohel, MD Venous Stent for the Iliofemoral Vein Investigational Clinical Trial Using the Duo Venous Stent System: 24-Month Results From the VIVID Trial Mahmood Razavi, MD Intra-Venous Fluid Challenge Results in Significant Change to Deep Pelvic Vein Cross-Sectional Area Khanjan Nagarsheth, MD VIVA Two-Year Outcomes of the LIFE-BTK Randomized Controlled Trial Evaluating the Esprit™ BTK Drug-Eluting Resorbable Scaffold for Treatment of Infrapopliteal Lesions Brian DeRubertis, MD Two-Year Outcomes From the PROMISE II Trial of Transcatheter Arterialization of the Deep Veins Daniel Clair, MD Thirty-Day Outcomes From the Disrupt PAD BTK II Study of the Shockwave Intravascular Lithotripsy System for Treatment of Calcified Below-the-Knee PAD Venita Chandra, MD Laser and Optics-Based Peripheral Intravascular Lithotripsy System for the Treatment of Above-the-Knee and Below-the-Knee Calcified Lesions: Results of the RESTORE ATK and RESTORE BTK trials Thomas Zeller, MD First Clinical Use of an Innovative Forward-Shifted Peripheral Intravascular Lithotripsy System: Late-Breaking Primary Outcomes of the Mini S/FORWARD PAD IDE Study John Corl, MD Prospective, Multicenter Evaluation of Transcarotid Artery Revascularization in Standard-Risk Patients: 30-Day Outcomes of the ROADSTER 3 Study Meghan Dermody, MD, MS Two-Year Outcomes of the PERFORMANCE II Trial: A Prospective, Multicenter, Single-Arm Investigation of a 3-in-1 Carotid Stent System With Integrated Embolic Protection William A. Gray, MD Healthcare Resource Utilization and Outcomes Among Patients With Intermediate-Risk PE Treated With Computer-Assisted Vacuum Thrombectomy vs Other Treatment Modalities Parag J. Patel, MD, MS Complete Two-Year Outcomes in Patients Receiving Mechanical Thrombectomy for Deep Vein Thrombosis in the CLOUT Registry David J. Dexter, MD Total REALITY: Comparison of Directional Atherectomy vs Balloon Predilatation Prior to Drug-Coated Balloon Treatment of Long, Calcified Femoropopliteal Lesions Venita Chandra, MD Final Results of the DETOUR2 Study: Durability of Percutaneous Transmural Arterial Bypass for Treatment of Complex Femoropopliteal Disease Sean P. Lyden, MD Retrievable Scaffold Therapy in Combination With a Paclitaxel-Coated Balloon: Two-Year Results of the DEEPER OUS Trial Thomas Zeller, MD How Sirolimus-Coated Balloon Angioplasty Compares to Various Paclitaxel-Coated Balloon Types–A Post Hoc Analysis of the Randomized SIRONA Trial Ulf Teichgräber, MD Impact of The Global Limb Anatomic Staging System (GLASS) on Clinical Outcomes in the LIFE-BTK Randomized Controlled Trial Hector Garcia, MD, PhD Diversity, Equity, and Inclusion in the LIFE-BTK Trial Evaluating the Esprit™ BTK Drug-Eluting Resorbable Scaffold for Treatment of Infrapopliteal Lesions in Patients With CLTI Lawrence A. Garcia, MD STRIDE Study Suggests Race, Not Sex, Is Associated With Outcomes in Acute Limb Ischemia Treated With Mechanical Aspiration Thrombectomy Alex Powell, MD Endovascular PAD Treatment With Drug-Eluting Devices in a Registry Focused on Underrepresented Minorities and Women: 12-Month Clinical Results From the First 500 ELEGANCE Registry Patients Lee Kirksey, MD *Order and presenters subject to change About the VIVA Foundation The VIVA Foundation, a not-for-profit organization dedicated to advancing the field of vascular medicine and intervention through education and research, strives to be the premier educator in the field. Our team of specialists in vascular medicine, interventional cardiology, interventional radiology, and vascular surgery is driven by the passion to advance the field and improve patient outcomes. Educational events presented by the VIVA Foundation have a distinct spirit of collegiality attained by synergizing collective talents to promote awareness and innovative therapeutic options for vascular disease worldwide. To learn more about the VIVA Foundation, visit . SOURCE The VIVA Foundation