What is a Venous Ulcer?

The definition of this blood vessel condition

vericose veins on woman's legs
huseyintuncer/E+/Getty Images

A venous ulcer is a shallow wound that develops on the lower leg when the leg veins fail to return blood back toward the heart normally — a condition known as venous insufficiency. They are also called varicose ulcer or stasis leg ulcer.

What Does It Look Like

The first sign of a venous ulcer is an area of dark red or purple skin, which may also become thickened, dry, and itchy. Without treatment, an open wound or ulcer may form.

The wound may be painful.

One of the first signs that a venous ulcer may be forming is that you may experience a dull ache or pain in the legs, swelling that subsides with elevation, eczematous changes of the surrounding skin, and varicose veins.

What Causes Venous Ulcers

The overall prevalence of venous ulcers in the United States is approximately 1 percent. Venous ulcers are more common in women and older persons. The primary risk factors are older age, obesity, previous leg injuries, deep venous thrombosis, and inflamed veins.

Risk of developing venous ulcers is increased by the presence of blood clotting disorders, pregnancy, obesity, a family history of varicose veins, smoking, excessive alcohol use, poor nutrition, or excessively long periods of inactivity or standing. Increased risk may also occur as a result of recent operative procedures. Another possible cause is if the calf muscle is ineffective at pumping, since it plays an important role of circulating the blood from the lower half of the body back to the heart.

How Are They Treated

Treating a venous ulcer requires the use of various methods to improve circulation. In the beginning treatment may include compression therapy and elevating your legs.

Compression therapy is the standard for treating venous ulcers, as proven by a 2009 Cochrane review article that found venous ulcers heal more quickly with compression therapy than without.

This could be because compression therapy reduces swelling, improves venous reflux, and reduces pain. Success rates range from 30 to 60 percent after 24 weeks, and 70 to 85 percent after one year, according to a American Journal of Medicine study. 

After an ulcer has healed, lifelong maintenance of compression therapy may reduce the risk of recurrence. There is also evidence that being active may also help prevent venous ulcers from occurring; especially when used in tandem with compression therapy.

The above can help prevent the ulcer from occurring, but if it has already formed medication may be needed. Aspirin is sometimes used as a therapy; but the evidence that it works is poor, according to a 2016 Cochrane review article. Another pharmaceutical option is Trental (Pentoxifylline), usually 400mg three times daily. This platelet aggregation inhibitor reduces blood viscosity, which improves microcirculation. It has been shown to be an effective adjunctive treatment for venous ulcers when added to compression therapy.

However, if venous ulcers become infected or resist healing for longer than 6 months, more aggressive treatments such as removal of tissue and bacterial burden through debridement, surgery to reduce venous reflux and prevent ulcer recurrence, and skin grafting may be needed.

Sources

Collins L, Seraj S. Diagnosis and treatment of venous ulcers. Am Fam Physician. 2010 Apr 15;81(8):989-96.

de Oliveira Carvalho PE, Magolbo NG, De Aquino RF, Weller CD. Oral aspirin for treating venous leg ulcers. Cochrane Database Syst Rev. 2016 Feb 18;2:CD009432. [Epub ahead of print]

Margolis DJ, Berlin JA, Strom BL. Which venous leg ulcers will heal with limb compression bandages? Am J Med. 2000;109(1):15–19.

Nelson EA, Adderley U. Venous leg ulcers. BMJ Clin Evid. 2016 Jan 15;2016. 

O'Meara S, Cullum NA, Nelson EA. Compression for venous leg ulcers. Cochrane Database Syst Rev. 2009;(1): CD000265.

Continue Reading