Do you have a sore on your leg that won’t go away — one that gets red, has some swelling and may weep fluid? If so, you may have a venous leg ulcer. And you shouldn’t ignore it, because it can lead to more serious problems.
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“Never ignore a venous leg ulcer,” says wound care specialist Jocelyn Ehren, CNP. “While the majority of vein illness symptoms are temporary and easily treated, venous leg ulcers are more severe and, when left untreated, can negatively affect your health.”
What separates venous leg ulcers apart from other diseases is the heightened risk of infection you have through an open sore.
“If you have a wound that hasn’t healed in two to three weeks, see your doctor or nurse practitioner right away,” she says. “They’ll evaluate you and get you a referral to a wound care center.”
What does a venous leg ulcer look like and what causes them?
Venous leg ulcers are sores that develop between your knee and ankle, but they typically form inside the leg near or around the ankle. They are large, shallow ulcers with uneven edges that drain or weep a lot.
You’ll likely see swelling in your leg, with red, itchy skin around the wound. You may also experience tightness in your calves, as well as aching, throbbing or a feeling of heaviness in your legs. Pooled and trapped blood often causes discolored splotches in the area.
“The sores sometimes affect only the skin or they may sink deeper into the fat layer, muscle, tendon and bone,” she says. “Severe ulcers are more likely to become infected and take longer to heal.”
Your veins carry blood back to your heart, and valves in the veins stop the blood from flowing backward. When your veins have trouble sending blood from your limbs to the heart, it’s known as venous insufficiency. In this condition, blood doesn’t flow back properly to the heart, causing blood to pool in the veins in your legs.
“Our veins are just like pipes,” says Ehren. “When there’s persistently high blood pressure in the veins of the legs (venous hypertension) with a valve that doesn’t work correctly, it causes damage to the skin, which eventually breaks down and forms an ulcer.”
Other possible causes for venous leg ulcers include:
- Varicose veins.
- Deep vein thrombosis (blood clots).
- Incompetent valves.
- Muscle weakness in the legs, leg injury or trauma.
- Swelling of a superficial vein (phlebitis).
Venous leg ulcers are the most common type of leg ulcer, accounting for 80% to 85% of all cases and mainly affecting older adults. Women are about twice as likely as men to have them — roughly 42% to 18%, respectively. Experts say a venous leg ulcer is more likely to occur in women between ages 40 and 49 and in men between ages 70 and 79.
While most heal within three months, some ulcers can take up to two years or more to finally get better. And a small number — approximately 15% — never fully go away.
What are my treatment options?
Treatment will depend on many factors, including the reason for the condition and your health status and history. Other factors your doctor will consider are:
- Your specific symptoms.
- Your age.
- How severe your condition is.
- How well you can tolerate medications or procedures.
“The most common treatment for venous insufficiency is prescription-wear compression stockings,” she says. “These special elastic stockings apply pressure at the ankle and lower leg. They help improve blood flow and can reduce leg swelling.”
You also can improve blood flow by keeping your legs elevated whenever possible, which means keeping them uncrossed when you are seated and by exercising regularly.
If you need medication, the most commonly prescribed include:
- Diuretics. These medications draw extra fluid from your body through your kidneys.
- Anticoagulants. These medications thin the blood.
- Pentoxifylline (Trental®). This medication helps improve blood flow.
When is surgery needed?
Sometimes, more serious cases of venous insufficiency require surgery. Your doctor may suggest one of the following:
- Surgically repairing veins or valves.
- Removing the damaged vein.
- Minimally invasive endoscopic surgery (a thin tube with a camera on it helps the surgeon see and tie off varicose veins).
- Vein bypass (a healthy vein is transplanted from somewhere else in your body).
- Laser surgery (uses lasers to either fade or close the damaged vein with strong surges of light in a small, specific place).
Surgical procedures include:
- Ambulatory phlebectomy. This outpatient procedure involves your doctor numbing certain spots on your leg and then making small picks and removing smaller veins.
- Sclerotherapy. This treatment method is generally reserved for advanced venous insufficiency. A chemical is injected into the damaged vein so that it is no longer able to carry blood. Blood will return to the heart through other veins, and the damaged vein will eventually be absorbed by the body.
- Catheter procedure. In severe cases, your doctor can place a catheter (a thin tube) into the vein, heat the end of it, and then remove it. The heat will cause the vein to close and seal as the catheter is taken out.
How is venous insufficiency diagnosed?
Your doctor will want to do a physical examination and take a complete medical history to figure out if you have venous insufficiency. They may also order some imaging tests to pinpoint the source of the problem. These tests may include a venogram or a duplex ultrasound.
Venogram. Your doctor will put an intravenous (IV) contrast dye into your veins. Contrast dye causes the blood vessels to appear opaque on the X-ray image, which helps the doctor see them on the image. This dye will provide your doctor with a clearer x-ray picture of your blood vessels.
Duplex ultrasound. A type of test called a duplex ultrasound may be used to test the speed and direction of blood flow in the veins. A technician will place gel on the skin and then press a small hand-held device (transducer) against your skin. The transducer uses sound waves that bounce back to a computer and produce the images of blood flow.
Can you prevent venous insufficiency?
If you have a family history of venous insufficiency, there are steps you can take to lessen your chances of developing the condition:
- Don’t sit or stand in one position for long stretches of time — get up and move around frequently.
- Don’t smoke and if you do smoke, do everything you can to quit.
- Get regular exercise.
- Maintain a healthy body weight.
Take these steps to prevent the development of venous leg ulcers, especially if you are at a higher risk. Also, if an ulcer does develop, talk to your doctor right away.