Treatment of venous insufficiency and venous ulceration has for many years relied on established principles of compression and limb elevation. Drug treatment has been of little benefit. In recent years, a better understanding of the pathological mechanisms underlying skin damage in venous disease has allowed more rational pharmacotherapeutic approaches to be made. This review examines these, with special reference to current theories of the cause of venous ulceration.
CallamM.J., RuckleyC.V., HarperD.R., DaleJ.J.Chronic ulceration of the leg: extent of the problem and provision of care. BMJ1985; 290: 1855–6
3.
DaleJ.J., CallamM.J., RuckleyC.V., HarperD.R., BerreyP.N.Chronic ulcers of the leg: a study of prevalence in a Scottish community. Health Bull1983; 41: 310–14
4.
BobekK., CajzlL., CepelakV., OpatznyK., BarcalR.Etude de la frequence des maladies phlebologiques et de l'influence de quelques facteurs etiologiques. Phlebologie1966; 19: 217–30
5.
CoonW.W., WillisP.W.III, KellerJ.B.Venous thromboembolism and other venous disease in the Tecumseh community health study. Circulation1973; 48: 839–46
6.
WilsonE.Prevention and treatment of venous leg ulcers. Health Trends1989; 21: 97
7.
BrowseN.L., BurnandK.G., Lea ThomasM.L.Diseases of the veins.Arnold, London, 1988
8.
BakerP.G., HaigG.Metronidazole in the treatment of chronic pressure sores and ulcers. Practitioner1981; 225: 569–73
9.
JonesP.H., WillisA.T., FergusonI.R.Treatment of anaerobically infected pressure sores with topical metronidazole. Lancet1978; i: 214
10.
GreavesM.W., SkillenA.W.Effects of long-continued ingestion of zinc sulphate in patients with venous leg ulceration. Lancet1970; ii: 889–91
11.
HallbookT., LannerE.Serum-zinc and healing of venous leg ulcers. Lancet1972; ii: 780–2
12.
GreavesM.W., IveF.A.Double-blind trial of zinc sulphate in the treatment of chronic venous leg ulceration. Br J Dermatol1972; 87: 632–4
13.
MyersM.B., CherryG.Zinc and the healing of chronic leg ulcers. Am J Surg1970; 120: 77–81
14.
PhillipsA., DavidsonM., GreavesM.W.Venous leg ulceration: evaluation of zinc treatment, serum zinc and rate of healing. Clin Exp Dermatol1977; 2: 395–9
15.
SchraibmannI.G., StrattonF.J.Nutritional status of patients with leg ulcers. J R Soc Med1985; 78: 39–42
16.
FelixW.Treatment of venous diseases by drugs. In: DavyA., StemmerR., eds. Phlebologie '89.London: John Libbey, 1989: 698–702
17.
MyersM.B., RightorM., CherryG.Relationship between edema and the healing rate of stasis ulcers of the leg. Am J Surg1972; 124: 666–8
18.
BalmerA., LimoniC.A double-blind placebo-controlled trial of VENORUTON on the symptoms and signs of chronic venous insufficiency. Vasa1980; 9: 76–82
19.
PulvertaftT.B.General practice treatment of symptoms of venous insufficiency with oxerutins. Results of a 660 patient multicentre study in the UK. Vasa1983; 12: 373–6
20.
BergqvistD., HallboeokT., LindbladB., LindhagenA.A double-blind trial of O-(β-hydroxyethyl)-rutosides in patients with chronic venous insufficiency. Vasa1981; 10: 253–60
21.
StegmannW., HuebnerK., DeichmannB., MuellerB.Wirksamkeit der O-(beta-hydroxyethyl)-rutoside bei der behandlung des venosen Ulcus cruris. Therapiewoche1986; 36: 1828–33
22.
PulvertaftT.B.Paroven in the treatment of chronic venous insufficiency. Practitioner1979; 223: 838–41
23.
RoztocilK., PrerovskyI.The effect of 7-monohydroxy-ethylrutoside on capillary filtration rate in the lower limb of man. In: DavyA., StemmerR., eds. Phlebologie '89.London: John Libbey, 1989: 719–21
24.
RudofskyG., DiehmC., GrubJ., HartmannM., Schultz-EhrenburgH.U., BislerH.Ruscus saponines and the flavanoid hesperidinmethylchalcone in the treatment of chronic venous insufficiency. In: DavyA., StemmerR., eds. Phlebologie '89.London: John Libbey, 1989: 728–30
25.
NeumannH.A.M., van den BroekMJTB. Evaluation of O-(β-hydroxyethyl)-rutosides in chronic venous insufficiency by means of non-invasive techniques. Phlebology1990; 5(Suppl 1): 13–20)
26.
de JongsteA.B., JonkerJ.J.C., HuismanM.V., ten CateJ.W., AzarA.J.A double-blind trial on the short-term efficacy of HR in patients with the post-thrombotic syndrome. Phlebology1990; 5(Suppl 1): 21–2
27.
NockerW., DiebschlagW., LehmacherW.Clinical trials of the dose-related effects of O-(β-hydroxyethyl)-rutosides in patients with chronic venous insufficiency. Phlebology1990; 5(Suppl 1): 23–6
28.
BrowseN.L., BurnandK.G.The cause of venous ulceration. Lancet1982; ii: 243–5
29.
BrowseN.L., GrayL., JarrettP.E.M., MorlandM.Blood and vein-wall fibrinolytic activity in health and vascular disease. BMJ1977; i: 478–81
30.
LeachR.D.Venous ulceration, fibrinogen and fibrinolysis. Ann R Coll Surg Eng1984; 66: 258–63
BrowseN.L., JarrettP.E.M., MorlandM., BurnandK.Treatment of liposclerosis of the leg by fibrinolytic enhancement: a preliminary report. BMJ1977; ii: 434–5
33.
BurnandK., LemensonG., MorlandM., JarrettP.E.M., BrowseN.L.Venous lipodermatosclerosis: treatment by fibrinolytic enhancement and elastic compression. BMJ1980; 280: 7–11
34.
LayerG.T., StaceyM.C., BurnandK.G.Stanozolol and the treatment of venous ulceration - an interim report. Phlebology1986; 1: 197–203
35.
DoddH.J., GaylardeP.M., SarkanyI.Skin oxygen tension in venous insufficiency of the lower leg. J R Soc Med1985; 78: 373–6
36.
MichelC.C.Aetiology of venous ulceration (letter). Br J Surg1990; 77: 1071
37.
Coleridge SmithP.D., ThomasP., ScurrJ.H., DormandyJ.A.Causes of venous ulceration: a new hypothesis. BMJ1988; 296: 1726–7
38.
SinzingerH., VirgoliniI., FitschaP.Pathomechanisms of atherosclerosis beneficially affected by prostaglandin E1 (PGE1) - an update. Vasa1989; supplement 28: 6–13
39.
BeitnerH., HamarH., OlssonA.G., ThyressonN.Prostaglandin E1 treatment of leg ulcers caused by venous or arterial incompetence. Acta Dermatouener (Stockholm)1980; 60: 425–430
40.
RudofskyG.Intravenous prostaglandin E1 in the treatment of venous ulcers - a double-blind, placebo-controlled trial. Vasa1989; supplement 28: 39–43
41.
RoekkaertsF., DeleersL.Trental 400 in the treatment of intermittent claudication: results of long-term, placebo-controlled administration. Angiology1984; 35: 396–406
42.
SullivanG.W., CarperH.T., NovickW.J., MandellG.L.Inhibition of the inflammatory action of interleukin-1 and tumour necrosis factor (alpha) on neutrophil function by pentoxifylline. Infect Immunol1988; 56: 1722–9
43.
WeitgasserH.The use of pentoxifylline (“Trental” 400) in the treatment of leg ulcers: results of a double-blind trial. Pharmatherapeutica1983; 3(Suppl 1): 143–51
44.
HergerR.The significance of the microcirculation in the treatment of leg ulcers. Therapiewoche1986; 36: 3818–28
45.
AngelidesN.S., Weil von der AheC.A.Effect of oral pentoxifylline therapy on venous lower extremity ulcers due to deep venous incompetence. Angiology1989; 40: 752–63
46.
ColganM-P, DormandyJ.A., JonesP.W., SchraibmannI.G., ShanikD.G., YoungR.A.L.Oxpentifylline treatment of venous ulcers of the leg. BMJ1990; 300: 972–5
47.
MullerB., KraisT., SturzebacherS., WittW., SchillingerE., BaldusB.Potential therapeutic mechanisms of stable prostacyclin (PG12) mimetics in severe peripheral vascular disease. Biomed Biochim Acta1988; 47: S40–4
48.
MusialJ., WilczynskaM., SladekK., CiernewskiC.S., NizankowskiR., SzczeklikA.Fibrinolytic activity of prostacyclin and Iloprost in patients with peripheral arterial disease. Prostaglandins1986; 31: 61–70
49.
BelchJ.J.F., SaniabadiA., DicksonR., SturrockR.D., ForbesC.D.Effect of Iloprost (ZK36374) on white cell behaviour. In: GryglewskiR.J., StockG., eds. Prostacyclin and its stable analogue Iloprost.Berlin: Springer-Verlag, 1987: 97–102
50.
MullerB., SchmidtkeM., WittW.Adherence of leucocytes to electrically damaged venules in vivo. Eicosanoids1988; 1: 13–17
51.
SturzebacherC.S., LosertW.Effects of Iloprost on platelet activation in vitro. In: GryglewskiR.J., StockG., eds. Prostacyclin and its stable analogue Iloprost.Berlin: Springer-Verlag, 1987: 39–45
52.
De FeliceM., GalloR., MasottiG.Current therapy of peripheral obstructive arterial disease. The non-surgical approach. Angiology1990; 41: 1–11
53.
van AckerK., RillaertsE., De LeeuwI.The influence of buflomedil on blood viscosity parameters in insulin-dependent diabetic patients: a preliminary study. Biomed Pharmacother1989; 43: 219–22
54.
DaumP.S., BowersW.D., TejadaJ., MorehouseD., HamletM.P.An evaluation of the ability of the peripheral vasodilator buflomedil to improve vascular patency after acute frostbite. Cryobiology1989; 26: 85–92
55.
MannarinoE., PasqualiniL., MaragoniG., OrlandiU.Effect of buflomedil chlorhydrate on local oxygen delivery in peripheral vascular disease. Angiology1989; 40: 559–62
56.
LavaudP., MatthieuJ., BienvenuP.Modulation of leucocyte activation in the early phase of the rabbit burn injury. Burns1988; 14: 15–20
57.
PincemailJ., DupuisM., NasrC.Superoxide anion scavenging effect and superoxide dismutase activity of Gingko biloba extract. Experientia1989; 45: 708–12
KurihariK., WardlawA.J., MoqbelR., KayA.B.Inhibition of platelet-activating factor (PAF)-induced chemotaxis and PAF binding to human eosinophils and neutrophils by the specific gingkgolide-derived PAF antagonist, BN 52021. J Allergy Clin Immunol1989; 83: 83–90
