Identifying Venous Leg Ulcers

Venous leg ulcers can be caused by chronic venous insufficiency (CVI)1.  This can be caused by reflux in any of the venous systems – whether superficialperforator, or deep – when the valves of the veins have failed or the vein has become obstructed2.  2014 SVS/AVF venous leg ulcer guidelines recommend comprehensive venous duplex ultrasound examination of the lower extremity in all patients with a suspected venous leg ulcer, in order to identify the cause3.

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 Step 1: Differentiate Arterial Ulcer From Venous Ulcer

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Ulcer appearance together with the medical history and physical exam should be used to determine the different diagnosis and see if a venous leg ulcer is suspected.

Step 2: Test for Chronic Venous Insufficiency (CVI)

Comprehensive Venous Duplex Ultrasound Examination of the lower extremity should be performed in all patients with a suspected venous leg ulcer in order to identify the cause.  The Society of Vascular Surgery (SVS) and the American Venous Forum (AVF) 2014 venous leg ulcer guidelines provide a strong recommendation for conducting this exam.

Step 3: Identify the Underlying Cause

Venous leg ulcers can be caused by chronic venous insufficiency (CVI)1, a more serious form of venous reflux disease which can cause reflux in any of the venous systems – superficial, perforator or deep.  Ultrasound testing will help define the underlying cause of this disease and help in determining the right treatment for patients.

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References:

1. Kanth A, Khan S, Gasparis A, Labropoulos N, et al. The distribution and extent of reflux and ob-struction in patients with active venous ulceration. Phlebology 2015; 30(5): 350-6.

2. Sufian S, Lakhanpal S, Marquez J, et al. Superficial vein ablation for the treatment of primary chronic venous ulcers. Phlebology 2011; 26: 301-6.

3. Thomas F. O’Donnell Jr et al. Management of venous leg ulcers: Clinical practical guidelines of the Society for Vascular Surgery and the American Venous Forum. J VascSurg 2014;60:3S-59S.