Leg Ulcers.

Leg Ulcers/Chronic Venous Insufficiency

Leg ulcers resulting from venous disease are often a great fear for patients with varicose veins.  While varicose veins can cause leg ulcers it is very unusual for ulcers to arise purely from varicose veins on their own.  Most ulcers arise as a result of incompetence of the deep veins.  Deep veins can become incompetent if the patient has had a deep venous thrombosis earlier in their life and sometimes this can be subclinical in that the patient may have been unaware that they have had a clot.  Once the clot resolves the deeper veins may not function quite as well as they did before and as a result the pressure in the vein increases and this is transmitted throughout the whole of the leg.  Through a series of local events this can produce a leg ulcer which is classically on the inner aspect of the ankle.  Unfortunately unlike varicose veins when deep veins are incompetent they are not surgically correctable.  The high pressures in these deep veins needs to be counteracted in order to produce the correct environment for healing.  This involves putting the patient in a bandage which is changed 1 – 2 times a week.  Many manufactures have their own brands of these bandaging systems and most are excellent.  Once the ulcer heals the patient needs to change to a compression stocking which unfortunately needs to be life long.  The patients with venous ulcers may also have varicose veins. If the ulcers are slow or refractory to healing, varicose vein treatments are often very helpful.  These treatments reduce the overall extent of the high venous pressure and may produce a better environment for the ulcer to heal.  The idea of varicose vein treatment with patients with co existent deep disease who have leg ulcers is a rapidly expanding area of interest.

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