Venous Ulcers

Chronic venous insufficiency (CVI) with ulceration is a common condition affecting 2-5% of the population. Ulcers are wounds or open sores that will not heal or keep returning. Historically, CVI was known as post-phlebitic syndrome and post-thrombotic syndrome, both of which refer to the aetiology of most cases. However, these names have been abandoned because they fail to recognize another common cause of the disease, the congenital absence of venous valves.

What are the symptoms of venous ulcers?

Ulcers may or may not be painful. The patient generally has a swollen leg and may feel burning or itching. There may also be a rash, redness, brown discoloration or dry, scaly skin.

What are the types of leg and foot ulcers?

The three most common types of leg and foot ulcers include:

Venous stasis ulcers
Arterial (ischemic ulcers)
Neurotrophic (diabetic)

Ulcers are typically defined by the appearance of the ulcer, the ulcer location, and the way the borders and surrounding skin of the ulcer look.

Venous stasis ulcers

Appearance

Causes

Typically, these lesions occur around the inner side just above the ankle, where venous pressure is greatest due to the presence of large communicating veins. The base of a venous ulcer is usually red. It may also be covered with yellow fibrous tissue or there may be a green or yellow discharge if the ulcer is infected. Fluid drainage can be significant with this type of ulcer.

The borders of a venous ulcer are usually irregularly shaped and the surrounding skin is often discoloured and swollen. It may even feel warm or hot. The skin may appear shiny and tight, depending on the amount of oedema (swelling). The skin may also have brown or purple discoloration about the lower leg, known as “stasis skin changes.”

Ulcers occur in people with poor blood circulation or in veins damaged from thrombosis. It can be a complication due to a medical or surgical procedure or following thrombosis.
Venous stasis ulcers are common in patients who have a history of leg swelling, long standing varicose veins, or a history of blood clots in either the superficial or the deep veins of the legs. Ulcers may affect one or both legs.

Venous ulcers affect 500,000 to 600,000 people in the United States every year and account for 80 to 90% of all leg ulcers.

Risk factors

Some risk factors for venous ulcers include the following:

Prolonged inactivity – Staying in bed or sitting for many hours, as in a car or on an airplane, creating stagnant or slow flow of blood from the legs in a dependent position (This pooling of blood in the legs leads to thrombus formation.)
Sedentary lifestyle – Not getting any exercise
Overweight and obesity
Cigarette smoking
Certain medical conditions, such as cancer or blood disorders, that increase the clotting potential of the blood
Injury to your arms or legs

Hormone replacement therapy or birth control pills
Pregnancy
Varicose veins
Age: Incidence of CVI rises substantially with age
Family history: History of deep vein thrombosis (DVT), which renders venous valves incompetent, causing backflow and increased venous pressure, is a risk factor.
Diseases like diabetes and polyneuropathy

Prevention

How can ulcers be prevented?

Controlling risk factors can help you prevent ulcers from developing or getting worse.

Here are some ways to reduce your risk factors:
Keep your skin moist Wear compression stockings Control your blood cholesterol and triglyceride levels by making dietary changes and taking medications as prescribed Limit your intake of sodium (salt)	Manage your diabetes and other health conditions, if applicable Exercise – start a walking program after speaking with your doctor Lose weight if you are overweight Quit smoking

Competence Centre for Minimally Invasive Medical Services

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