West Los Angeles         Alhambra        Ontario        Victorville

Venous Leg Ulcer Treatment

Understanding Severe
Vascular Disease

Venous ulcer treatment with superficial vein ablation

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.

Venous ulcer treatment specialist Dr. Michael Lalezarian in Los Angeles, California

Your Vascular Partner

Dr. Michael Lalezarian

Timely, accessible care is paramount in the effort against arterial ulcers, venous ulcers, and their complications.

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.

5-Star Arterial Ulcer and Venous Ulcer care in Los Angeles
“He is truly dedicated, and an extraordinary physician who’s really concerned with his patients!”

Adrianne S, October 2018

Venous Insufficiency

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, 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 insufficiency progression from varicose veins to venous ulcers

Venous Leg Ulcers Causes

To understand how venous leg ulcers 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 the early stages of 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.

Causes of venous leg ulcers healthy vs. vein reflux vs. obstruction
Your Partner in Vascular Care
Venous Ulcer Treatment in Los Angeles

Venous Leg Ulcers Symptoms

Leg Ulcers

The lower leg undergoes major changes when venous insufficiency gets serious:

  • 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

Venous insufficiency causes blood to pool in the veins and leak into surrounding tissues, causing:

  • 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

Venous insufficiency can cause a variety of pain patterns:

  • 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

A simple ultrasound exam is the first step to verify if you’re living with venous insufficiency. More advanced imaging techniques, such as venogram and intravascular ultrasound, may be necessary to assess more complex vein pathologies.
Venous ulcer diagnosis with leg ultrasound
Your Partner in Vascular Care
Venous Ulcer Treatment in Los Angeles

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

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 treatment is used, this is a catheter-based, outpatient procedure that is performed through a single tiny puncture in the leg.

Deep Vein Revascularization

Deep vein revascularization is an image-guided procedure in which blood flow obstructions in the deep veins are opened up to improve blood flow and circulation. Flow obstructions can be caused by venous reflux, extrinsic compression, a blood clot, or chronic occlusion. A few different techniques are used by a Vascular Specialist to address these unique pathologies:

  • 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 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.

Venous leg ulcer

Your Partner in Vascular Care

Venous Ulcer Treatment in Los Angeles
More Resources
Peripheral Artery Disease Screening: Why Early Detection is Critical in PAD
Peripheral Artery Disease Screening: Why Early Detection is Critical in PAD
PAD signs, symptoms, risk factors, and screening methods.
Endovascular Treatment of Lower Extremity Arterial Disease
Endovascular Treatment of
Lower Extremity Arterial Disease
A brief 101 on the treatment options available for arterial disease.
Los Angeles Vascular Specialist Dr. Michael Lalezarian
Vascular Specialist in Los Angeles
Learn more about Los Angeles Vascular Specialist Dr. Michael Lalezarian.
References

[1] Eberhardt (2014). Contemporary Views in Cardiovascular Medicine: Chronic Venous Insufficiency. Circulation. 2014;130:333-346.
[2] Meissner (2005). Lower Extremity Venous Anatomy. Seminars in Interventional Radiology. 2005;22(3):147-156.
[3] Cesarone (2002). ‘Real’ epidemiology of varicose veins and chronic venous diseases: the San Valentino Vascular Screening Project. Angiology 2002; 53: 119–130.
[4] Meissner (2016). What is effective care for varicose veins? Phlebology, 31(1_suppl), 80–87.
[5] Gohel (2018). A Randomized Trial of Early Endovenous Ablation in Venous Ulceration. New England Journal of Medicine, 378(22), 2105–2114.
[6] 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.
[7] Lohr (2010). Radiofrequency Ablation: Evolution of a Treatment. Seminars in Vascular Surgery, 23(2), 90–100.

Schedule Your Visit

or contact us about a referral
Call ProVascularMD Vascular Treatment Center in Los Angeles, California

PHONE

Call us any time
M-F, 9am-5pm
Message ProVascularMD Vascular Treatment Center in Los Angeles, California
MESSAGE
Click the Chat Button
Get connected now with our
instant messaging widget.
Email ProVascularMD Vascular Treatment Center in Los Angeles, California
EMAIL
Email us or use the
contact form below.
You can also use this contact form
for general inquiries.

14 + 1 =