Understanding Venous Insufficiency and Venous Ulcers

What are the treatments for venous ulcers?

If you have been diagnosed with venous ulcers, the major goal of treatment is to improve blood circulation in your legs. A combination of lifestyle changes and medical treatment are very effective in treating venous ulcers. Follow your cardiologist’s instructions to heal the ulcers and prevent both recurrence and serious complications.
 

Other treatments that may be ordered by your doctor include:

Good wound care for venous ulcers is a major part of treatment to promote healing and prevent infections, complications and recurrence. The doctors and staff at Jackson Heart Clinic will show you how to take care of the open wound. There are different types of dressings that may be recommended, and they can be purchased at most pharmacies or other stores. In general, a lightweight, non-stick gauze dressing or other material will be recommended to be placed right over the wound, then a larger bandage will be placed on top to keep it in place.

• Keep the wound clean and covered with a bandage all of the time, except when bathing or cleaning the wound.
• Change the dressing at least every day. You may need to change it more often if drainage seeps through or the bandage gets wet.
• Clean the wound thoroughly before you dress it. Use a mild soap and water.
• Make sure to also keep the skin around the wound clean.
• Wear a compression stocking over the dressing and bandage to help with swelling and to improve blood flow to your legs. This will also help keep the bandage in place.
• Keep alert to signs of infection, such as increased drainage, a bad smell, increased redness, heat, swelling or pain. If you feel that the wound is worse or becoming infected, contact our office right away for further instructions.

Compression stockings are proven to help venous circulation and are usually required for treatment. They should be worn always except for bathing and sleeping.

Lifestyle changes can help prevent or treat venous ulcers. Elevating legs above heart level or preventing them from hanging down can help circulation in your legs. For example, pillows under your legs when in bed or propping legs up when sitting will really help keep blood from pooling in your legs. If you have work that requires you to be on your feet a lot, take breaks and elevate your feet and legs as often as possible. If heavy lifting is required, ask for help.

Exercise can help improve blood flow and venous circulation. Your cardiologist will discuss how much exercise and what types of exercise will be best for your particular medical situation.

Weight loss can be helpful in the treatment of venous ulcers. If you need help with that, ask your physician for guidance.

Medication may be needed to treat infection or to help heal the ulcer.
Surgery may be an option if your physician finds that it is needed to prevent further problems. Minimally invasive techniques (such as the Venefit™ procedure, described below) are available on an outpatient basis to treat impaired veins.

Other types of surgery such as vein ablation, vein stripping, angioplasty or stents may be required. Skin grafting may also be needed for very hard, difficult to heal or deep ulcers. In that case, more detailed information will be given to you by your cardiologist to help you understand your treatment options.

 

The Venefit Procedure™ is performed by your cardiologist using ultrasound and positioning a catheter (small tube) through the skin into the diseased vein. The catheter is powered by radio frequency energy (RF) that produces heat within the vein wall to shrink and close off the vein. Once that vein is closed, the body will naturally re-route blood to other healthy veins.

 

A simple bandage will be placed over the site after the procedure and compression stockings may be recommended to help the healing process. Your cardiologist may also recommend walking, but may also caution against standing for extended periods of time or to avoid strenuous exercise for a while. Usually patients can resume normal activities within a few days after the procedure.

The procedure can be done as an outpatient, under local anesthesia, and patients usually experience relief of symptoms in a short period of time. Additionally, closing off the diseased vein will ultimately have a positive cosmetic effect, reducing the size of diseased superficial veins and discoloration of the skin in that area.

As with any procedure, complications can occur and include bruising, blood clots, blood vessel perforation, infection and emboli (a blood clot that moves), nerve damage and others, but are infrequent. Complications are less frequent when the physician has performed many of these procedures and selects patients who are most likely to benefit (and does not select patients for the procedure who have contraindications, such as those patients who have existing clots in the vein to be treated).