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

Case Diagnosis: A new approach for the treatment of chronic venous
disease: the impact of extracorporeal shockwave therapy -

Case Description: Patient information and clinical findings: 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.

Conclusions: ESWT induces tissue regeneration, angiogenesis, and
lymphangiogenesis, positively impacting clinical outcomes.