Ulcers are wounds or open sores that will not heal or keep returning. Venous ulcers constitute the majority of all leg ulcers, of which up to 80% are caused by venous disease. Venous ulcers are the result of untreated or neglected chronic venous insufficiency (CVI). CVI is characterized by valves in the veins not closing properly, which causes venous reflux. In the past the treatment of these ulcers included application of ointments, elastic stockings, leg elevation and medicated bandages like the Unna’s boots. In severe cases, hospital surgery was necessary with fairly large incisions in attempt of closing the so-called incompetent veins, which are at the root of these ulcers.
Symptoms of Venous Stasis Ulcers
Ulcers may or may not be painful. The patient generally has a swollen leg and may feel burning or itching. There may also be a rash, redness, brown discoloration or dry, scaly skin. Ulcers are typically defined by the appearance of the ulcer, the ulcer location, and the way the borders and surrounding skin of the ulcer look.
Venous Stasis Ulcers: Appearance
Typically, these lesions occur around the inner side just above the ankle, where venous pressure is greatest due to the presence of large communicating veins. The base of a venous ulcer is usually red. It may also be covered with yellow fibrous tissue or there may be a green or yellow discharge if the ulcer is infected. Fluid drainage can be significant with this type of ulcer.
The borders of a venous ulcer are usually irregularly shaped and the surrounding skin is often discolored and swollen. It may even feel warm or hot. The skin may appear shiny and tight, depending on the amount of edema (swelling). The skin may also have brown or purple discoloration about the lower leg, known as stasis skin changes.
Venous stasis ulcers are common in patients who have a history of leg swelling, long standing varicose veins, or a history of blood clots in either the superficial or the deep veins of the legs. Ulcers may affect one or both legs.
The causes and risk factors of venous ulcers are similar to those of CVI. Risk factors associated with chronic venous insufficiency are age, family history and lifestyle.
The following may also be indicative of CVI:
- Varicose veins (whether or not treated)
- Proven deep vein thrombosis in the affected leg
- Phlebitis in the affected leg
- Suspected deep vein thrombosis (for example, a swollen leg after surgery, pregnancy, trauma or a period of enforced bed rest)
Once CVI is properly diagnosed with an ultrasound study and a consult with a specialist, treatment for these venous ulcers can now be done in the comfort in the physician’s office. Endovenous ablation (closure) of the greater saphenous vein (the long vein along your inner thigh) along with the subsequent ablation (closure) of the perforating vein or veins will restore proper blood flow. Once proper blood flow has been established the ulcer heals. This elegant procedure can end the ulcer process for patients that have spent years going back and forth to wound care centers.