Chronic Venous Insufficiency causes venous hypertension in the lower extremities and contributes to a variety of health issues, such as pain, swelling, surface skin changes, venous stasis dermatitis, and venous ulcers. Venous edema, (swelling), and reduced circulation impede ulcer healing, compressing small blood vessels, creating dead tissue, increasing the likelihood of developing a venous stasis ulcer and possibly an infection.
Treating venous stasis ulcers is sometimes tricky, but this doesn’t mean that it’s impossible! When appropriate, Physicians try conservative treatment, before recommending surgery.
Venous Pathophysiology 101!
When blood pools in extremities, pressure increases within a space-limited vessel, and to compensate the vein irreversibly changes its shape, altering the lining of the vein wall, and damaging valvular structures. Over time venous hypertension compromises lymphatic function, causing fluid to leak into the tissues of the legs and feet.
Unfortunately, the lymphatic system is unable to drain the excess fluid, leading to stasis dermatitis and venous ulcers. Poor circulation obstructs blood flow to the wound, limiting crucial immune factors that assist with wound healing. A vicious cycle continues, whereby, venous hypertension and edema result in the release of inflammatory substances, contributing to slow healing ulcers.
Venous Stasis Ulcers
Venous Stasis Ulcers (VSUs) are shallow wounds that usually occur on the sides of the lower legs, ankles or calves. They are challenging to treat because of reduced blood flow and sometimes become infected. Preventing VSUs from developing is the cornerstone of Chronic Venous Insufficiency treatment.
If you are experiencing lower extremity swelling and observe changes in the color of your skin, reach out to your Doctor. These are symptoms of Chronic Venous Insufficiency and indicate you are at risk of developing a VSU.
Venous Ulcer Skin Characteristics:
Hyper-pigmentation ~ The medical term that describes a reddish or brownish change in skin color.
Lipodermatosclerosis ~ This means hardening or thickening of the skin.
Eczema ~ This is common lingo for the itchy, dry and flaky skin.
Conservative Management of Venous Ulcers
Compression stockings help to heal ulcers and prevent new ones from forming! Simply put, stockings facilitate the venous return to the heart and improve lymphatic drainage. Your Physician may recommend a medication, Pentoxifylline, to assist with blood circulation and enhance healing. If you cannot tolerate compression stockings, Pentoxifylline, is used as a monotherapy.
Calcium Channel Blockers (CCBs) are a class of medications that treat venous hypertension. Nifedipine (Procardia) and Diltiazem (Cardizem) are two commonly prescribed CCBs that effectively reduce high venous pressures and vessel wall stiffness.
Some VSUs require wound debridement to remove dead tissue, enhancing healing! A wound care team usually manages post-operative dressings. Several different bandages promote healing and improve comfort.
Here are some available dressings:
Proteolytic enzyme agents
Vacuum-assisted wound therapy (Wound Vacs)
Bacterial colonization of VSUs is common, and your Doctor will prescribe antibiotics to treat the infection. Whether you receive oral or intravenous antibiotics, depends on your clinical presentation and what your Doctor recommends.
Minimally Invasive Vein Procedures
If you observe bluish bulging veins underneath your skin consider taking a Vein Quiz! Knowing your Vein Score and understanding more about your health can help you guide your next Doctor appointment! If at risk of developing venous insufficiency, ask your Physician for a referral to a Vein Specialist for further assessment. You may benefit from Varicose Vein Treatments, like EVLT or RFA, that halt the progression of venous insufficiency pathology.
Venous Surgical Approaches
Stasis ulcers that take three or more weeks to heal may benefit from a venous ablation procedure, such as EVLT or Radiofrequency ablation. The goal of the treatment is to correct valve incompetence, an underlying variable that contributes to Chronic Venous Insufficiency. A quality initial ultrasound should correctly identify the poorly functioning veins. It is essential to seek treatment from qualified vein doctors with many procedures and years of experience.
Without adequate blood flow to the affected extremity, wound healing stalls. Whether your doctor recommends conservative management or surgery, the goal of either treatment is to improve venous circulation, enhancing wound healing ultimately!
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