Venous Stasis Ulcer
Venous stasis ulcer is a common type of leg and foot ulcer. Venous legs ulcers are sores on your leg that typically takes more than a month to heal, and they can be quite painful. Venous stasis ulcer is an example of a circulation problem called chronic venous insufficiency, and this is a debilitating leg problem in which blood does not flow normally up through the veins in the legs toward the heart. In normal veins a series of specialized, one-way valves work together, opening to allow blood to flow upward, then closing to keep the blood from flowing back toward the feet. Venous insufficiency occurs when valves are damaged or not functioning properly. As the valves deteriorate, blood leaks or flows backward and pressure in the vein increases, stretching and dilating the vessel. Blood stagnates (pools) in the veins of the lower legs, increasing the blood pressure in the legs, and causing chronic inflammation in the veins.
People with long-term, untreated venous insufficiency sometimes develop open sores in the skin called venous ulcers. Ulcerations develop in areas where blood collects and pools, as swelling there interferes with the movement of oxygen and nutrients through tissues. Over time a visible ulcer develops on the skin. Venous ulcers usually appear just above the ankle on the inside of the leg. If they are not treated they can become quickly infected or even gangrenous.
In addition to a complete medical history and physical examination, diagnostic procedures for chronic venous insufficiency may include any, or a combination, of the following:
Duplex ultrasound. This is a type of vascular ultrasound procedure done to assess blood flow and the structure of the leg veins. The term "duplex" refers to the fact that two modes of ultrasound are used - Doppler and B-mode. The B-mode transducer (like a microphone) obtains an image of the vessel being studied. The Doppler probe within the transducer evaluates the velocity and direction of blood flow in the vessel.
Magnetic resonance venography (MRV). This is a diagnostic procedure that uses a combination of a large magnet, radiofrequencies, and a computer to produce detailed images of organs and structures within the body. An MRV uses magnetic resonance technology and intravenous (IV) contrast dye to visualize the veins. Contrast dye causes the blood vessels to appear opaque on the x-ray image, allowing the physician to visualize the blood vessels being evaluated. MRV is useful in some cases because it can help detect causes of leg pain other than vein problems.
Chronic venous insufficiency
There are several minimally invasive treatments for venous insufficiency, which are aimed at reducing swelling and improving the return of blood to the heart.
Elevating the legs (above the heart) when not standing helps the blood return to the heart, decreases blood pooling, and ultimately decreases swelling.
Exercise, which stimulates the calf muscles and increases circulation, may also be recommended.
Doctors treat venous ulcers by working to prevent infection and promote healing of the wound. Many novel treatments, outlined below, are now available to help heal venous ulcers.
Topical creams - Doctors sometimes advise patients to use a topical cream containing hydrocortisone to minimize itching, provided it is not applied to open skin. Anti-fungal creams can also prevent infection from developing on the skin of the feet and toes. However, people with venous insufficiency are advised not to use antibiotic creams because they worsen inflammation.
Compression stockings - The most common treatment for venous insufficiency is compression stockings. These special stockings apply constant, even pressure to the leg. This increases circulation and prevents blood from flowing backward, thereby reducing much of the swelling caused by the disorder. In addition, compression stockings can help prevent venous ulcers from forming or can help accelerate the healing of an existing ulcer.
Unna boots - An Unna boot is a moist gauze bandage that is applied around the lower leg, from the region of the ulcer to just below the knee. The gauze hardens to form a snug boot on the leg. The support from the boot helps improve blood flow in the veins and heal the ulcer. The boot stays on for 48 hours to two weeks and then is replaced if the wound has not healed.
Hydrocolloid dressings - A hydrocolloid dressing is a specialized bandage with a breathable outer layer that keeps liquid, bacteria, and viruses out, and an inner layer that absorbs drainage from the wound to promote healing. The dressing also helps to remove any non-living tissue from the wound (a process called debridement). The dressing is changed every 1 to 7 days.
Laser treatment - Laser treatment may be indicated for chronic venous insufficiency in which certain veins in the leg are needed to closed permanently to reduce the pressure around the venous ulcers. The physician inserts a tiny fiber into a varicose vein through a catheter. The fiber sends out laser energy that destroys the diseased portion of your varicose vein. The vein closes and your body eventually absorbs it.
Ablation procedure - Ablation involves the insertion of a thin, flexible tube called a catheter inserted into abnormal veins in the leg. The tip of the catheter heats the walls of the vein using either laser or radiofrequency energy to destroys the vein tissue. Once destroyed, the vein is no longer able to carry blood and is absorbed by your body.
If you would like to see a physician at the University Vascular Associates, please check our physician information and call us for an appointment. Our physicians see patients in offices throughout Southern California. Our office locations and phone numbers are listed below.