Venous Ulcer Treatment & Symptoms

Venous ulcers are the most severe manifestation of a condition called chronic venous insufficiency. Venous insufficiency is a broad term in medicine that is used to describe any vein abnormality that causes insufficient blood through the veins of the leg.

In its least severe form, venous insufficiency can cause medically insignificant spider veins, but as the disease progresses from the early stages, 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. Read on to learn about venous insufficiency ulcer treatment.

Venous Leg Ulcers Causes

To understand what causes venous leg ulcers to develop, it’s important to first understand the anatomy of the veins. When we talk about veins in the legs, we tend to talk about them in two categories: deep and superficial. The deep veins sit deep within the leg, and are the main channel by which blood travels from the legs back to the heart. On the other hand, superficial veins run closer to the surface of the leg and drain blood into the deep veins. The superficial veins can be seen as bulging varicose veins in early stage venous leg ulcers and venous insufficiency.

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

Leg Ulcers

• 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

Leg Swelling

• 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 Pain

• 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

• 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 in Los Angeles

Venous Leg Ulcer Treatment

The root venous leg ulcer cause 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

Superficial vein closure is the gold standard to treat varicose veins that are contributing to venous ulceration. The phrase ‘superficial vein closure’ describes a variety of minimally invasive treatments that are used to close down varicose veins. This can be done by applying thermal energy, a specially formulated chemical irritant, or glue to the inside of the vein. Regardless of which venous leg ulcer treatment is used, this is a catheter-based, outpatient procedure that is performed through a single tiny puncture in the leg.

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.

Compression Stockings

Compression stockings are usually prescribed by general practitioners as a conservative, first-line therapy for venous insufficiency. They can help relieve venous leg ulcer symptoms by improving blood flow through the veins. However, this improvement in blood flow does not address the underlying pathologies involved in venous insufficiency, so continuous long-term use is required for stockings to be effective. Many patients have trouble staying compliant with their stocking prescription, which can render them ineffective.

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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Venous Leg Ulcer Treatment in Los Angeles