Venous Insufficiency Ulcers

Descriptive text is not available for this image BASICS

  • Venous stasis ulcers are the most common type of chronic leg ulcers, affecting 1–3% of the American population.
  • Venous stasis ulcers are the most serious consequence of chronic venous insufficiency, which is a condition that occurs when the venous wall and/or valves in the leg veins are not working effectively, making it difficult for blood to return to the heart and causing stasis.
  • Diagnosis is based on history and physical examination with characteristic appearances and location of the ulcers along with signs of chronic venous insufficiency.
  • Important to rule out coexisting arterial insufficiency, wound infection, and other etiologies.
  • Treatment consists of compression and absorbable dressing.

DESCRIPTION

  • Irregular and shallow skin ulcers with well-defined borders, red granulation on the wound bed, and large amount of serous discharge
  • Most common locations are lower legs below calves and malleolar regions.
  • Surrounding tissue shows signs of venous insufficiency, such as edema, varicose veins, hyperpigmentation, scaly skin, fibrotic skin, atrophie blanche (scars from previous ulcers), and lipodermatosclerosis (champagne bottle appearance).
  • Usually mild pain unless infected or complicated with arterial insufficiency.
  • They can spontaneously develop, or after minor trauma failing to heal without proper treatment.

EPIDEMIOLOGY

Chronic leg ulcers are caused by venous insufficiency, arterial insufficiency, or mixed venous and arterial insufficiency (48%, 15%, and 18%, respectively).

Incidence

  • The overall incidence of venous ulcers is 18/100,000 persons; more common in women than men (20.4 versus 14.6/100,000); incidence increases with age in both men and women.
  • >20,000 patients are newly diagnosed with venous ulcers in the United States yearly.

Prevalence

  • Prevalence of venous stasis ulcers is estimated to be 4% worldwide.
  • Venous insufficiency is a chronic condition with a high recurrence rate of 66% within 5 years of closure.

ETIOLOGY AND PATHOPHYSIOLOGY

  • Venous insufficiency is a chronic condition with a high recurrence rate of 66% within 5 years of closure.
  • Venous hypertension comes from the following:
    • Venous obstruction (e.g., tumor compression, thrombus, obesity)
    • Incompetent venous valves (primary or secondary after thrombus)
    • Calf muscle pump dysfunction (e.g., debility, myopathies, neuropathies)

RISK FACTORS

  • Obesity, older age, female, family history of venous disease
  • History of deep venous thrombosis (DVT); history of venous insufficiency disease
  • Failure of the calf muscle pump (e.g., ankle fusion, inactivity, debility, paralysis)
  • Prolonged standing or sitting; history of multiple pregnancies

GENERAL PREVENTION

  • Wear compression garments if any signs of venous insufficiency (e.g., edema, venous dermatitis, varicose veins) with or without history of DVT
  • For patients who had venous stasis ulcers, lifelong compression therapy is recommended due to severity and chronic nature of venous insufficiency.

COMMONLY ASSOCIATED CONDITIONS

  • Secondary lymphedema due to venous insufficiency, or obesity related lymphedema of the legs is common.
  • Coexisting infection and arterial insufficiency are also common.

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