Comprehensive Venous Diagnosis and Treatment
Venous stasis ulcers, also known as venous leg ulcers, are open, poorly-healing or nonhealing wounds associated with stasis dermatitis skin changes such as a red or brown discoloration of the skin anywhere from the foot to the calf. Stasis ulcers represent an advanced form of stasis dermatitis with skin breakdown due to a very minor injury.
Venous stasis ulcers nearly always heal with local wound care, compression stockings, and elevation and exercise. All patients with venous stasis ulcers should be evaluated with lower extremity venous color duplex ultrasound once the swelling is controlled to evaluate for venous reflux (valve failure) and obstruction.
Treatment for venous reflux may help with more rapid healing and clearly reduces the risk of recurrent stasis ulcer development. See the treatments for venous stasis dermatitis.
The Society for Vascular Surgery and the American Venous Forum have initiated a plan to reduce the incidence of venous leg ulcers in the US by 50% over the next 10 years. It is known that 1-1½ % of the health care budget of western countries is spent on treating venous leg ulcers. Proper diagnosis and treatment will heal the vast majority of venous leg ulcers. More importantly, proper diagnosis and treatment of stasis dermatitis before venous leg ulcers develops will prevent the vast majority of problems associated with venous leg ulcers.
Unfortunately, many facilities that perform ultrasound of the leg veins do brief testing which is designed only for detecting deep vein thrombosis. Since stasis dermatitis and venous leg ulcers are usually due to venous insufficiency, for which many ultrasound laboratories do not test, the diagnosis often is delayed by multiple nondiagnostic ultrasound tests. The Society for Vascular Surgery and the American Venous Forum recognize that existing standards for performance of venous reflux testing must be followed to evaluate patients for leg swelling, tenderness, pain or abnormal skin changes in order to achieve the vascular societies’ goal of reducing the incidence of venous leg ulcers. Considerable education of testing facilities, referring physicians, and patients to demand venous reflux testing is essential.