Medically reviewed by Thomas Alosco, MD, DABS, RPVI, RVT, DABVLM on May 23, 2024
Venous leg ulcers are open sores that are slow to heal and are caused by poor blood flow in the leg veins. This blood circulation problem, the result of vein disease, accounts for 60 to 75 percent of leg ulcers in the United States, according to Center for Vein Restoration vein specialist Dr. Thomas Alosco. Further, four percent of the U.S. population over the age of 65 have what's called venous stasis ulcers, making this symptom of chronic venous insufficiency a health concern for hundreds of thousands of adults nationwide.
We spoke to Dr. Thomas Alosco, lead vein physician at Center for Vein Restoration (CVR) vein clinic in Waterbury, Connecticut, about venous leg ulcers, including the causes, treatment, and long-term management of this common and sometimes debilitating disorder.
Dr. Thomas Alosco: “Venous ulcers are caused by a vein problem called venous insufficiency, a condition where the valves in the leg veins do not work properly and fail to pump blood back up toward the heart effectively. When these valves malfunction, blood pools in the veins, leading to increased pressure and inflammation. This causes the veins to become dysfunctional and leak blood and fluid into the surrounding tissues. The leakage and inflammation irritate the skin, progressing to the formation of a venous ulcer if left unchecked.”
Dr. Thomas Alosco: “Venous disease is somewhat of an unrecognized disease because it's sort of an indolent process (i.e., a disease that progresses slowly and does not pose an immediate threat) that patients suffer with daily and that rarely requires emergent intervention. However, it’s important to understand that vein disease is chronic (that is, it lasts for more than three months and may get worse over time).”
"Vein disease is actually much more common than peripheral arterial disease and coronary artery disease, affecting millions of people worldwide. Despite its prevalence, venous disease is often unrecognized and goes undiagnosed and untreated, leading to potentially serious complications like venous ulcers." – Dr. Thomas Alosco
Dr. Thomas Alosco: “The early signs of a venous ulcer are skin changes like hyperpigmentation (darkening of the skin) and erythema (redness due to inflammation). The deposition of blood in the tissues causes the iron to stain the skin, leading to hyperpigmentation or a blackish discoloration. This hyperpigmentation and inflammation are early indicators that venous disease is affecting the skin—and if left unchecked, can progress to skin breakdown and form an ulcer.”
Dr. Thomas Alosco: “Venous ulcers are typically located around the ankles, both medially (toward the middle or center) and laterally (to the side). They are characteristically superficial (close to the surface), painless, can be large in size, and are usually clean without infection. However, they often fail to heal or will recur because the underlying venous insufficiency is not addressed.
By contrast, arterial ulcers are usually found on the feet or toes and are very painful, while diabetic ulcers are also commonly on the plantar surface of the feet and are painless due to neuropathy. The location, pain level, and appearance of the ulcers help differentiate venous ulcers from arterial ulcers and diabetic ulcers.”
Dr. Thomas Alosco: “Managing venous ulcers involves two aspects: treating the ulcer itself and addressing the underlying venous insufficiency to prevent recurrence.
For the ulcer, debridement of necrotic tissue, control of bacterial load with topical or systemic antibiotics, and elimination of edema (swelling) are crucial. Reducing edema through compression therapy is vital, as swelling impairs wound healing, especially in the lower extremities, where gravity is a factor. Compression helps mobilize fluid back towards the heart.
But again, unless the root cause of venous insufficiency is treated, venous ulcers tend to heal only temporarily but recur repeatedly.”
The nation's leading authority on treating venous disease, the root cause of venous stasis ulcers, Center for Vein Restoration (CVR) delivers compassionate, comprehensive care for vein disease in a comfortable outpatient setting.
As America's largest physician-led vein center with over 110 locations across 22 states and 70+ practicing physicians, CVR boasts a 98% patient satisfaction rate, offering exceptional expertise in managing venous insufficiency and preventing venous stasis ulcers.
Call 240-965-3915 to speak to a Patient Services Representative or schedule your consultation online at a CVR near you today.
Dr. Thomas Alosco: “To address the underlying venous insufficiency causing ulcers, we start by performing an ultrasound to identify the problematic veins with faulty valves and reflux. These incompetent veins are then shut down through outpatient, well-tolerated procedures like chemical ablation, glue, or thermal ablation, typically taking under an hour with no downtime.
We start by treating the major axial veins, like the great and small saphenous veins, but also target their tributary branch veins. Importantly, perforating veins that directly connect the deep and superficial venous systems are a major culprit, pouring blood into the ulcer base. Ablating these perforators with laser fibers leads to a dramatic improvement in ulcer healing once the pathologic venous flow is stopped.
Dr. Thomas Alosco: “Compression therapy is crucial. We commonly use inelastic, rigid stockings or wraps like the zinc-impregnated Unna boot. These are applied and changed as needed, depending on wound drainage. Controlling drainage is important, as excessive moisture promotes bacterial overgrowth, impeding healing.”
When treating venous ulcers, it's essential to rule out any underlying arterial insufficiency, as adequate blood supply is necessary for wound healing. Compression aids venous return but must be used cautiously if arterial disease is present.”
According to the Clevland Clinic, arteries are blood vessels responsible for transporting oxygen-rich blood from the heart to all parts of the body. This continuous supply of oxygenated blood is essential for the proper functioning of organs and tissues. However, when the arteries become compromised and cannot effectively deliver an adequate amount of blood, it puts the body at risk of developing severe health issues.”
"At Center for Vein Restoration, our dedicated and skilled nursing staff excels in providing comprehensive compression therapy support, which is crucial for compliance and successful treatment outcomes. As a specialized vein practice, we understand the challenges patients face with compression stockings. Our nurses patiently guide patients through the proper fitting, application, and wear, encouraging adherence to this vital aspect of care. Their expertise and commitment ensure patients receive the encouragement and assistance needed to maintain consistent compression therapy." – Dr. Thomas Alosco
Dr. Thomas Alosco: “Studies show that early intervention in correcting the problematic veins leads to faster ulcer healing and significantly reduces the risk of recurrence.
Many patients experience a cycle of temporary healing followed by ulcer recurrence when only the ulcer itself is treated without addressing the root cause—venous insufficiency. At a dedicated vein center, treating the venous insufficiency alongside ulcer care can achieve complete healing, with timeframes ranging from 6-8 weeks to 6-8 months, depending on the ulcer's severity and duration.”
Dr. Thomas Alosco: “Like any ulcer, venous ulcers can worsen over time if neglected. Unaddressed, they risk becoming severely infected, potentially leading to significant tissue loss. Though limb loss is rare with venous ulcers, any unchecked infectious process will inevitably progress and cause further complications. Prompt treatment is crucial to prevent deterioration and promote healing of venous ulcers.”
85 percent of venous ulcers heal within 24 weeks, depending on size. Monitoring for granulation tissue growth indicates healing progress. Wound care must be adjusted based on drainage levels, using products to stimulate healing in clean wounds, and antimicrobial dressings for bacterial overgrowth.
Center for Vein Restoration (CVR) provides expertise in selecting and prescribing the appropriate wound care products, which get delivered directly to patients' homes through our wound care program partnership. This empowers patients to become active participants in regularly changing dressings between office visits, a crucial component for effective venous ulcer healing when combined with our in-office treatments.
Dr. Thomas Alosco: “Patients should start by consulting their primary care physician and pointing out any leg ulcers. Most doctors can differentiate between arterial, diabetic, and venous ulcers based on their appearance and location and then provide the appropriate referral.
For suspected venous ulcers, they will typically refer to a vein specialist. Many patients also self-refer directly to vein specialists, who can evaluate the ulcer. If confirmed as venous, they initiate a full venous disease workup and treatment. However, if it appears arterial or diabetic in nature, the vein specialist ensures proper referral to vascular surgeons, wound care centers, or diabetes management as needed for those specific ulcer types.”
Understanding the importance of early intervention, comprehensive care, and addressing underlying venous insufficiency is paramount to achieving optimal healing outcomes. At Center for Vein Restoration, our commitment to compassionate, patient-centered care is the heart of our approach to vein care.
If you or someone you know is suffering from venous leg ulcers, don’t hesitate to seek help. With our nationwide network of vein specialists and state-of-the-art treatments, we’re here to support you on your journey to healing and improving your vein health.
Call 240-965-3915 today to speak to a Patient Services Representative or schedule your consultation online at a Center for Vein Restoration location near you. Let’s take the first step towards healthier, happier legs together.
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