Ulcerations (Venous Insufficiency)

Venous insufficiency can cause many unpleasant symptoms. In addition to leg swelling and pain, some individuals will experience skin changes and may even develop open sores or ulcerations. These ulcerations are usually found on the legs and are sometimes called venous ulcers (venous leg ulcers), venous insufficiency ulcers, stasis ulcers (stasis leg ulcers), or varicose ulcers. It is very important to get ulcerations treated right away to prevent serious health consequences. Continuing treatment for venous insufficiency can also reduce your risk of leg ulcers and help keep them under control.

Causes of Ulcerations

Ulcerations on the legs are usually caused by venous insufficiency. This condition occurs when increased pressure on the vein walls causes blood to leak into the subcutaneous tissues. This fluid leakage can cause edema and may gradually break down these tissues, which results in the development of an open wound skin ulcer.

Causes and risk factors for venous insufficiency with ulcerations include:

  • Family history of vein problems with or without leg ulcers
  • Personal history of vein problems with or without leg ulcers
  • Pregnancy (especially multiple pregnancies)
  • Other hormonal changes (such as menopause)
  • Obesity
  • Age (individuals over age 50 are at higher risk)
  • Gender (females are at higher risk)
  • Smoking
  • Varicose veins
  • Deep vein thrombosis (blood clot in the leg)
  • Heart failure
  • Peripheral vascular disease
  • Diabetes mellitus
  • Personal history of blood clots
  • Blockages in the lymphatic system, which cause fluid buildup
  • Edema
  • Lack of exercise
  • High blood pressure
  • Frequent standing or sitting in place for extended periods of time

Symptoms of Venous Ulcers

Early warning signs of ulcerations include leg swelling, heaviness, and cramping in the legs. The affected area of skin may discolor and take on a dark red, purple, brown, or even yellowed appearance, signs of the blood pooling beneath. Itching and tingling may also be present. Once the ulceration has developed, it will appear as a shallow, open wound with uneven borders. The shallow sore will have a red base, sometimes with an overlay of yellow tissue. The wound itself may be relatively painless, while the surrounding skin may be shiny, tight, discolored, and warm or hot (cellulitis). Often, when a wound is present, stasis dermatitis (skin inflammation) will occur and the whole leg will become swollen.

Ulcerations commonly become infected, in which case the wound may drain pus and develop an unpleasant odor. If not treated right away, the infection can travel through the bloodstream into the bone (osteomyelitis). Serious health consequences, including sepsis (a life-threatening complication) and the possible need for amputation, can result. 

Treatment for Leg Ulcers

Leg ulcers due to venous insufficiency are often difficult to heal and likely to get infected. Individuals known to have venous insufficiency should get treatment early on to reduce their risk of developing these ulcerations. For those at higher risk of leg ulcers, watch for early symptoms and get treatment right away when warning signs appear. For individuals who already have a venous ulcer, treatment includes a combination of wound care, pressure relief, and prevention.

Varicose Veins
  • Wound Care for Leg Ulcers

  • Pressure Relief for Ulcerations

  • Prevention of Stasis Ulcers

Prevention of Stasis Ulcers

Prevention is a critical treatment strategy for individuals who currently have one or more leg ulcers and for individuals who are at greater risk of developing them. Prevention of venous ulcers begins with monitoring your legs and feet every day. Carefully inspect the tops and bottoms of your legs, ankles, feet, toes, and heels, and look for the early warning signs listed above and any cracks or changes in skin color. It is also recommended that you adopt the following lifestyle improvements:

  • Exercise regularly
  • Manage weight (weight loss may be recommended)
  • Reduce salt intake
  • Wear compression garments
  • Avoid sitting or standing for long periods of time
  • Avoid crossing legs or ankles while sitting
  • Avoid temperature extremes
  • Quit smoking
  • Manage diabetes
  • Manage blood pressure
  • Manage cholesterol
  • Get good sleep

These preventive measures are usually life-long commitments and may need to be combined with other vein treatments.

Treatment for Venous Insufficiency

Ulcerations are often difficult to heal and may return. Therefore, in addition to treating existing ulcers, it is very important to control the underlying condition to prevent future ulcerations. Venous insufficiency treatments can include:

  • Medications: Medications to prevent blood clots may be prescribed for those with deep vein thrombosis, which can cause ulcerations. 
  • Sclerotherapy: Sclerotherapy can be an effective way to disable spider veins and varicose veins that cause fluid leakage resulting in stasis ulcers. Sclerotherapy treatment injects a sclerosant (a chemical irritant) into damaged veins, disabling the vein walls and causing the veins to gradually fade away. 
  • Endovenous Laser Ablation Treatment (EVLA): Laser energy can be used to disable leaky veins. After a laser fiber is inserted into the vein, laser energy is transmitted into the vein and the fiber is withdrawn, causing the vein to close.
  • ClosureFastâ„¢: Using radiofrequency energy, we can close problematic veins to reduce the likelihood of ulcerations. 
  • VenaSealâ„¢: This proprietary medical adhesive can seal off varicose veins to reduce the likelihood of ulcerations. 
  • Ambulatory Phlebectomy: Ambulatory phlebectomy is a micro-extraction procedure that surgically removes sections of varicose veins using a phlebectomy hook. 
  • Ligation: In ligation, the damaged vein is surgically cut and tied off so that blood can no longer flow through it. 
  • Stripping: Stripping is the surgical removal of larger damaged veins through two small incisions.
  • Vein Bypass: With vein bypass, a portion of healthy vein is transplanted from another area of the body to reroute blood flow. This treatment is performed only on the upper thigh and is reserved for the most severe cases of venous insufficiency, for which no other treatment is effective.

Our highly experienced staff can help you determine which treatments may be most effective for your specific situation.