What is Deep Venous Insufficiency and Venous Ulcers?

Deep venous insufficiency is a chronic condition in which the deep veins of the legs are not effectively returning blood to the heart. It can occur because the valves in the deep vein system are damaged (valvular incompetence) allowing blood to pool in the calf veins. This in turn creates leg edema and pressure on the skin, which causes skin damage, called venous stasis change.

Venous ulcers are a not infrequent outcome of long-term untreated deep venous insufficiency. These ulcers appear mostly on the lower legs, at the level of the ankle. They can be caused by minor trauma, such as bumping the leg or scratching, and are painful and slow to heal.

The incidence of venous insufficiency rises with age. Other risk factors for venous insufficiency include a sedentary lifestyle, obesity, untreated varicose vein disease or deep venous thrombosis (DVT).

How are Deep Venous Insufficiency and Venous Ulcers Diagnosed?

The most common early sign of deep venous insufficiency is chronically swollen ankles. Swelling may be accompanied by a dull aching, cramping, or feeling of heaviness in the legs and feet that becomes worse after prolonged standing.

As it progresses, venous insufficiency also leads to patches of brown discoloration and deterioration (flaking or hardening) of the skin around the ankles. Complications of chronic venous stasis disease include skin infection (cellulitis) and development of venous ulcers.

Duplex ultrasound will help to determine whether there is venous incompetence.

What Treatment Options are Available?

Treatment of deep venous insufficiency is directed at reducing leg swelling and improving return of the blood upwards towards the heart. Elevation of the legs (above the heart) when not standing helps the blood return to the heart, decreases blood pooling, and ultimately decreases swelling. Any exercise which uses the calf muscles also helps to promote return of venous blood to the heart.

Graduated compression stockings help to decrease swelling by applying external pressure to the leg. Skin protection (keeping the legs covered, avoiding sun exposure, and applying a regular skin moisturizer) is imperative in avoiding the development of venous ulcers and skin infection.

Venous Ulcer (Wound) Care

Venous ulcers can be a challenge to heal. Treatment for ulcers includes pain control, reduction of edema, and wound dressings. Sometimes minor surgery (wound debridement) is required to remove any non-living tissue from a wound so that it can heal properly. Antibiotics may be needed to treat infection. If significant superficial venous incompetence is identified by ultrasound, surgical treatment with ligation or RFA ablation may be advised. (see Varicose Vein section)

The choice of treatment is tailored to the individual patient’s needs.