Venous leg ulcers develop when blood flow is seriously impaired in the major veins of the leg. They typically form on the back of the lower leg between the mid-calf and the ankle bone, and are usually accompanied by skin discoloration, skin hardening, itchiness, and leg pain.
The goal of venous leg ulcer treatment is to restore healthy blood flow through the veins. While less severe vein disease can usually be addressed with superficial vein closure, venous ulcers often have deep vein obstructions that must be addressed as well to allow the leg to heal. Venous ulcer treatment at ProVascularMD is provided by a Vascular Specialist that is trained in superficial vein closure and deep vein revascularization.
Your Vascular Partner
Dr. Michael Lalezarian
Dr. Michael Lalezarian is a double-board certified Vascular Interventional Radiologist specializing in minimally invasive venous ulcer treatment. He is a committed partner in the battle against the devastating consequences of advanced vascular disease.
Adrianne S, October 2018
In its least severe form, venous insufficiency can cause medically insignificant spider veins, but as the disease progresses, varicose veins may develop and the affected leg(s) may become swollen and painful. As more veins are affected and blood flow is further compromised, the lower half of the leg can undergo major changes in appearance and ulcers can develop. In most individuals with venous insufficiency, this disease process takes place over several years and many cases aren’t symptomatic until later stages of disease.
Venous Leg Ulcers Causes
Deep and superficial veins are connected by deep-superficial junctions and perforator veins. This connectivity is important because flow problems in the deep veins can cause flow problems in the superficial veins and vice versa.
There are multiple ways in which venous insufficiency can develop, and venous ulcers are often the manifestation of multiple sources of venous insufficiency.
Reflux – Vein reflux is a medical phrase that is used to describe when blood flows backwards in a vein. Healthy veins have one-way valves that prevent back flow, but when these valves fail, blood accumulates in the affected vein, increasing pressure and stifling flow. Reflux is the cause of most cases of varicose veins, but can occur in deep veins as well.
Compression – Vein anatomy differs from person to person. In some individuals, major veins are compressed by nearby anatomical structures. This increases pressure and obstructs blood flow. May-Thurner syndrome, also referred to as iliocaval venous compression syndrome or iliac vein compression syndrome, is one such condition in which a major artery presses a major vein against a bony structure in the groin area. In a similar way, obesity is thought to cause venous insufficiency by compressing major veins in the abdominal region.
Obstruction – Because veins are low-flow, low-pressure vessels, they are susceptible to the formation of blood clots (thrombus) that obstruct flow. Clots can develop in both superficial and deep veins (deep vein thrombosis). Clots are often more serious in deep veins, especially when they form above the knee. If left untreated, clots in the veins harden into permanent obstructions, causing blood flow challenges throughout the veins.
Post Thrombotic Syndrome – In recent years, vascular specialists have found that venous insufficiency can persist even after the successful treatment of deep vein thrombosis. The presence of thrombus is thought to instigate a chronic inflammatory response that compromises the integrity of the veins over time.
Venous Leg Ulcers Symptoms
- Ulcer – usually forms between the mid-calf and the ankle bone
- Skin color changes – red-brown coloration or whitening of the leg can occur
- Eczema – parts of the skin become red and itchy
- Lipodermatosclerosis – the skin becomes tough and inflexible
- Edema – the leg becomes swollen with fluid
- Varicose veins – swollen, bulging veins coursing along the surface of the leg
- Heaviness – swelling can make the legs feel heavy
- Fatigue, especially when active
- Leg cramps, especially at night
- Claudication – thigh / leg pain and tightness when exercising
- Aching, soreness, restless legs, or burning throughout the leg
- Venous ulcer pain
Venous Ulcer Risk Factors
- Age – the older you get, the more likely you are to develop venous insufficiency
- Gender – women are more likely than men to be diagnosed with venous insufficiency
- Lifestyle or Occupation – extended periods of sitting, standing, or low mobility are thought to contribute to venous insufficiency
- Obesity – vein compression in the abdomen may increase your risk of venous insufficiency
- Family History – venous insufficiency may run in your family
- Smoking – smoking has been shown to increase the risk of venous insufficiency
Venous Ulcer Diagnosis
Venous Leg Ulcer Treatment
The root cause of a venous ulcer is severely insufficient blood flow in the veins of the leg. For this reason, venous ulcers are often referred to as ‘venous stasis ulcers,’ and treatment strategies are focused on improving blood flow throughout the venous system. In many cases, both superficial and deep vein problems must be addressed to fully heal the leg.
When you see a Vascular Specialist, the goal of venous leg ulcer treatment is to ‘close down’ superficial vein disease, and to ‘open up’ deep vein disease. The idea here is to improve blood flow through the deep veins and to improve circulation in the superficial veins by re-routing blood flow through healthy veins nearby. Although these two treatments require different tools and very different approaches, they can both be performed by a Vascular Specialist using image-guided, minimally invasive techniques.
Superficial Vein Closure
Deep Vein Revascularization
- Angioplasty – a balloon device is positioned along the length of the obstructed vein and inflated, forcing the obstruction to open.
- Stenting – a tubular support device made out of a special metal or polymer is placed along the length of the deep vein obstruction and left in the vein to help it stay open after the procedure.
- Thrombectomy – a mechanical device is used to remove clot or chronic occlusion from a deep vein.
Venous Wound Care
Wound care consists of self-care techniques, special dressings / bandages, therapies, medications, and lifestyle adjustments that keep the venous ulcer clean and promote healing of the skin. While wound care does not address the underlying vein problems that cause venous ulcers, wound care is an essential part of healing and should be continued when other treatments are pursued.
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Lower Extremity Arterial Disease
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 Meissner (2005). Lower Extremity Venous Anatomy. Seminars in Interventional Radiology. 2005;22(3):147-156.
 Cesarone (2002). ‘Real’ epidemiology of varicose veins and chronic venous diseases: the San Valentino Vascular Screening Project. Angiology 2002; 53: 119–130.
 Meissner (2016). What is effective care for varicose veins? Phlebology, 31(1_suppl), 80–87.
 Gohel (2018). A Randomized Trial of Early Endovenous Ablation in Venous Ulceration. New England Journal of Medicine, 378(22), 2105–2114.
 Kankam (2017). A summation analysis of compliance and complications of compression hosiery for patients with chronic venous disease or post-thrombotic syndrome. European Journal of Vascular and Endovascular Surgery, 55:406-416.
 Lohr (2010). Radiofrequency Ablation: Evolution of a Treatment. Seminars in Vascular Surgery, 23(2), 90–100.
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