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Patient Education

Venous Leg Ulcers: Causes, Treatments & Prevention

At Dekalb Vein Center, we see many patients with venous leg ulcers. This painful condition can greatly deplete a person’s quality of life. Some patients cope with it for years, not knowing that more effective treatments are available. If you or someone you know lives in the Atlanta area and is suffering from venous leg ulcers please contact our office to discuss your treatment options.

What are venous leg ulcers?

Venous leg ulcers are chronic, open wounds. They typically occur on the low leg or ankle and are very slow to heal. They can last anywhere from a few weeks to several years and may never fully heal at all. Ulcers that do heal often come back after a period of time.

What causes venous ulcers?

Venous leg ulcers are caused by a condition called venous insufficiency.

Healthy veins regulate blood flow using tiny, one-way valves that keep your blood flowing towards your heart. In patients with venous insufficiency, the valves have become weakened or damaged so that blood refluxes (flows backwards) and pools inside the vein.

Over time, pooled blood increases pressure in the vein and fluid begins to seep out into surrounding tissues. This is known as fluid retention or edema. Excess fluid irritates the dermal (skin) tissue causing inflammation and, over time, breakdown. Broken down tissue results in an ulcer.

What do venous ulcers look like?

Venous leg ulcers are typically large, shallow sores with uneven edges, though a patient may also present with one or more smaller sores. They can occur anywhere but are most common on the inside of the lower leg near the ankle. The skin around the ulcer is often discolored and thickened. The leg itself will usually be swollen. The ulcer may be itchy, painful, and drain or weep a lot.

Who gets venous leg ulcers?

Anyone can get a venous leg ulcer. However, most of the patients we see are older and have underlying medical conditions such as hypertension (high blood pressure) or obesity. Women are also more likely than men to develop them.

One of the biggest risk factors for developing a venous leg ulcer is having varicose veins; though, not everyone with varicose veins will develop leg ulcers nor does everyone with leg ulcers have visible varicose veins.

Other risk factors for venous leg ulcers include:

  • Being a woman over the age of 40
  • Leading a sedentary lifestyle
  • Having a history of smoking
  • Having a history of blood clots
  • Being overweight
  • Having high blood pressure
  • Being diabetic
  • Being pregnant

What can venous ulcers lead to?

If not properly cared for, a venous leg ulcer can become infected. The infection may present as cellulitis, where the skin and subcutaneous tissues around the wound become inflamed, warm, painful, and tender to the touch.

In the worst cases, infection can progress to septicemia (infection of the blood) or osteomyelitis (infection of the bone), which would then require hospitalization and possible amputation. However, this is not common and can usually be avoided with proper wound care. That’s why it’s very important to see your doctor for your venous ulcer and follow all their instructions.

How are venous leg ulcers treated?

Wound care helps keep the venous ulcer infection free so it can heal. This may involve:

  • Regular wound cleaning
  • Dressing the wound with sterile pressure bandages
  • Application of topical antibiotics and/or topical antibodies to treat infection
  • Removing unhealthy tissue from the wound (debridement)

Compression stockings and keeping the leg elevated as much as possible help keep blood from pooling in the leg and causing further damage.

The underlying cause of the venous ulcer also needs to be addressed.

Venous insufficiency is treated with a procedure called venous closure that redirects blood flow from the damaged vein to nearby, healthy veins. This stops blood from pooling in the leg in the first place which allows the venous ulcer to heal and, in most cases, not come back.

There are several safe, outpatient venous closure procedures available including:

  • Sclerotherapy
  • Radiofrequency or laser ablation
  • Vein glue

How to prevent venous ulcers?

There is no guaranteed way to prevent venous ulcers.You can, however, greatly lower your risk by taking good care of yourself.

  • Avoid smoking
  • Maintain a healthy weight
  • Get regular exercise
  • Take regular breaks to move if you sit at work

Compression stocking can also help reduce swelling and prevent blood from pooling in the legs.

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