Venous ulcers are one of the two most dreaded complications of vein disease, the other being blood clots. Overall, more than 1% of all Americans will develop a leg ulcer (a chronic open, draining wound). 80% of all leg ulcers are caused by vein disease. Untreated venous reflux (valve failure) in the great saphenous vein (GSV), small saphenous vein (SSV), or in a perforating vein, can lead to the formation of a venous ulcer. These ulcers are the result of chronic high pressure in the veins and usually occur on the lower legs in patients with untreated venous disease.
The most common location for venous ulcers is just above the ankle bone on the inside of the leg. This is because the GSV is the longest vein in the leg and reflux in it creates the highest pressure on the tissues of the lower leg. The best way to prevent venous ulcers is to treat venous disease long before an ulcer develops. It usually takes years after the first signs of venous disease are apparent before an ulcer develops, giving patients plenty of time to take preventive measures.
Once a venous ulcer appears, it should be treated with compression therapy. All venous ulcer patients should have a complete leg vein mapping ultrasound to determine the cause. Treatment of the underlying vein disease can be done before the ulcer is healed and can help speed the healing of the ulcer. Venous ulcers are also less likely to recur if the underlying vein disease is treated.
Treatment of the underlying disease associated with venous ulcers almost always involves a combination of EVLT and ultrasound-guided foam sclerotherapy injections to close down all veins supplying pressure to the ulcerated area. At ERVC we use the VenaCure EVLT® 1470 Laser from Angiodynamics® (http://www.angiodynamics.com/products/venacure-evlt) to close down refluxing saphenous veins.
Clovis E. Manley, MD
Evansville Regional Vein Center
A venous ulcer on this patient's shin. 80% of all leg ulcers are due to venous disease. The most common location of venous ulcers is on the inside of the lower leg.
Ulcer on the lateral leg resulting from great saphenous vein reflux with a large number of dilated tributary veins under the ulcer.