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How Do Venous Ulcers Form?

Venous ulcers are a consequence of progressive valvular dysfunction in the veins that return blood from the legs back to the heart.  They usually occur from untreated and progressive abnormalities in the superficial veins that are an inherited condition. Patients initially present with varicose veins and spider veins but if untreated swelling will begin to occur. Chronic swelling will eventually result in discoloration of the skin of the lower leg and ankle because the plasma that leaks into the skin tissues contains a brown pigment. Initially, this pigment will cause an allergic reaction which will cause itching and is reversible. Eventually if left untreated the skin will become permanently altered as it becomes scared and fibrotic from constant exposure to the pigment. Eventually, the skin becomes so abnormal that the normal nutrient capillary arterial flow to the skin is disrupted and then the skin breaks down causing a venous ulcer.

Most commonly the ulcer occurs on the medial ankle but can occur outside of the ankle as well. It is always associated with brown fibrotic skin changes. It should not be confused with arterial ulcers which are a result of insufficient arterial blood flow down to the legs. These ulcers are not associated with swelling or brown discoloration and usually occur on the top of the feet. Patients with arterial ulcers experience cramping in their calf after walking several blocks called claudication. The pain is relieved when patients stop walking as they are not using the muscles that are deprived of oxygen-rich arterial blood.

Venous ulcers will respond by minimally invasive  “endovenous” methods to close the veins with the abnormal valves. Luckily these superficial veins can be closed without any consequence to the blood return of the leg.  The ulcers will usually heal within one month after treatment.

Patients who have had previous deep venous thrombosis(clots) can also develop venous ulcers. The deep venous clot causes valve dysfunction of the deep veins which also will result in swelling and brown discoloration. The location of the ulcers is more variable and treatment options are limited.  Venous ulcer patients who have superimposed problems in both the superficial and deep systems will respond to the treatment of their abnormal superficial veins. These complex situations are very patient-specific and require consultation with Dr. Albert to determine the best appropriate treatment.

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