802 - A new approach for the treatment of chronic venous disease: the impact of extracorporeal shockwave therapy - a case report

Case Diagnosis: Chronic venous disease

Case Description: An 80-year-old woman underwent left transfemoral amputation in 2022 due to osteomyelitis stemming from an infected venous ulcer. Initially referred for prosthetic rehabilitation, she presented with her contralateral limb at risk of amputation, showing signs of poor peripheral perfusion, thready pulses, cutaneous pallor, distal cyanosis, and significant edema below the knee.
Physical examination revealed additional findings including livedo, non-pitting edema, erythema, hyperkeratotic skin, and scars from venous ulcers. She underwent three sessions of focused extracorporeal shockwave therapy (f-ESW) in the contralateral limb aimed at improving perfusion and venous return. Subsequent to treatment, improvements were observed in perfusion, edema reduction, and temperature increase, culminating in enhanced pulse amplitudes post-treatment.

Discussions: Extracorporeal Shockwave Therapy (ESWT) is a non-invasive, non-pharmacological treatment option that is easy to administer, accessible, safe, and reportedly free of side effects. When used in vascular diseases, it offers a rapid and cost-effective alternative compared to current conventional treatments, reducing both direct and indirect costs associated with hospitalization and surgical procedures. ESWT improves tissue perfusion through various mechanisms, thereby preventing the development of wounds and their associated complications.
ESWT involves sonic pulses characterized by short-duration pressure peaks. Its anti-inflammatory and immediate analgesic effects were evident after the first session, significantly reducing the patient's signs and symptoms. Serial measurements showed reduced edema in the calf and ankle circumference, increased local perfusion, and alleviation of limb discomfort. 















In the medium to long term, ESWT induces tissue regeneration, angiogenesis, and lymphangiogenesis, positively impacting clinical outcomes.




























 

Conclusions: The use of f-ESWT not only prevented limb amputation but also led to significant improvements in the patient's quality of life and mobility, with sustained long-term results. To our knowledge, this case report represents the first study to utilize f-ESWT in a patient with severe Chronic Venous Disease (CVD), demonstrating promising results.