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    1. Treatment of superficial vein reflux (see Varicose Veins, above) has been shown to decrease the recurrence rate of venous ulcers. Where there is substantial obstruction of the femoral or popliteal deep venous system, superficial varicosities supply the venous return and should not be removed.

      Failure of venous insufficiency ulcerations to heal is most often due to inconsistent use of first-line treatment methods. Ongoing control of edema is essential to prevent recurrent ulceration; the use of compression stockings following ulcer healing is critical, with recurrence rates 2–20 times higher if compression stockings are not used

      Duplex ultrasound evaluation should assess blood flow direction, venous reflux, and venous obstruction, and include examination of the deep venous system, great saphenous vein (GSV), small saphenous vein (SSV) and its thigh extension (Giacomini vein), accessory saphenous veins, and perforating veins. Venography is recommended primarily in patients with post-thrombotic disease, especially when intervention is planned, as it provides greater anatomic detail than duplex ultrasonograph The examination also identifies patterns of disease that have treatment implications. Axial reflux is defined as uninterrupted retrograde flow from groin to calf and can occur in either superficial or deep systems. [4] Junctional reflux is limited to the saphenofemoral or saphenopopliteal junction, while segmental reflux occurs in a portion of a truncal vein. [4] Understanding whether reflux originates from superficial junctions versus deep venous incompetence fundamentally changes treatment planning, as superficial disease is amenable to ablation while deep disease typically requires conservative management Management of secondary varicose veins from post-thrombotic syndrome (PTS) is fundamentally different and more challenging. Compression therapy, lifestyle modifications, and symptom management form the cornerstone of PTS treatment. [4-8] Elastic compression stockings (20-30 mm Hg), leg elevation, weight loss, and exercise constitute the primary therapeutic approach Endovascular interventions for PTS—including percutaneous transluminal venoplasty and stenting—are reserved for select patients with significant iliofemoral obstruction who have failed conservative management. [7] These procedures require careful patient selection and standardized criteria. The role of superficial venous ablation in PTS patients with concomitant superficial reflux remains controversial and should be approached cautiously, as the underlying deep venous pathology may limit benefit

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  2. May 2022
  3. Jan 2022
    1. Is ITIL Losing Importance Due To SaaS? ITIL is a set of procedures and practices of IT service management when we mistakenly believe that we don't have to worry about that in SaaS. However, ITIL has many aspects and facets that encompasses running IT in an organization. Moreover, it is not a checklist for the implementation of specific services in specific environments. For SaaS, we can just use a different toolset to follow the general ITIL guidelines.

    1. The Business Strategy stems from a detailed strategic planning process. However, the question we want to answer in this article is whether we can execute multiple strategies side by side while they do not interfere with each other. We compare multiple strategies for business, information provision and IT and focus on Strategic planning.

      Business strategy alignment and the secrets of strategic planning https://en.itpedia.nl/2022/01/02/business-strategie-alignment-en-de-geheimen-van-strategische-planning/ The Business Strategy stems from a detailed strategic planning process. However, the question we want to answer in this article is whether we can execute multiple strategies side by side while they do not interfere with each other. We compare multiple strategies for business, information provision and IT and focus on Strategic planning.

  4. Nov 2021
  5. Feb 2021
  6. Oct 2020
  7. Oct 2018