They are a debilitating form of ulceration, which is extremely hard to fix, painful and expensive due to the high burden of wound care and dressings that are required.
Venous ulcers are a venous circulation problem. The exact cause of the failed venous drainage can be multi-faceted.
Ageing – A patient may have had varicose veins for twenty years, and then one day, they begin to develop ulcers. Advanced age is a risk factor for ulcers because:
Malnutrition – Whilst being overweight increases pressures in veins (mentioned above in the causes section), being malnourished impedes one’s ability to rejuvenate and recover tissue that is being damaged. This can promote ulcers
Genetics – Some families are more prone to venous disease
Leg trauma or surgery – People who have undergone surgery on the ankles or lower legs, often orthopaedic trauma from broken bones and car accidents, are more prone to venous disease. It is not uncommon to see a patch of pigmentation from venous disease around old traumatic injuries
Pregnancy – As mentioned in the deep vein thrombosis and varicose vein sections, pregnancy hormones and expanded blood volume place one at higher risk of varicose veins. As this is a cause of venous ulcers, pregnancy is a risk factor for venous ulcers.
Smoking – Causes damage to blood vessels, delays wound healing and contributes to the formation of venous ulcers.
Prolonged standing or sitting – Jobs that do not enable pumping of the calf muscle, with prolonged periods of sitting and standing, generally have pooling of blood in their lower limbs, promoting venous hypertension and vein damage.
The most important intervention to heal a venous ulcer is applying compression bandages. The compression bandages should be medical-graded compression, tighter around the foot and ankle, and gradually less tight going up towards the knee. They should be changed as frequently as required to squeeze out the oedema of the leg and prevent fluid that leaks out of the ulcer from damaging the surrounding skin that isn’t ulcerated (i.e., change the dressings when they are soiled, depending on how much fluid is coming out of the ulcer). Dressing changes are done three times per week in the first week, then dropped to twice weekly when less fluid in the soft tissue leaks out of the leg.
Before compression garments can be applied, the arteries supplying the foot must be adequate to provide blood to the toes. However, still, after the tight compression garments go on, Patients with blocked arteries may have terrible complications from compression garments if their blocked arteries are not managed first. If a patient has blocked arteries and damaged veins, we call the ulcer a ‘mixed’ ulcer rather than purely a venous ulcer. See the section on peripheral arterial disease to learn more about these treatments.
If varicose veins are identified, treating these varicose veins improves circulation and reduces venous hypertension, speeds up venous ulcer healing and reduces venous ulcer recurrence. See the section on varicose veins to learn about these treatments.
The larger iliac vessels in the pelvic may be chronically occluded. These large vessels can be corrected with stents placed through keyhole surgery. This can only be done if there is enough flow into the stent, or else the stent will block. Your leg should be assess for suitability for deep venous reconstruction prior to undergoing any procedure. If there are blocked vesels in the groin or pelvis, with relatively healthy flow in the veins below these larger vessels, then deep venous intervention can help venous return immensely, resulting in symptom resolution and even ulcer healing.
Aortic dissection is a complicated condition that requires a long conversation about its implications and cannot easily be explained through website content delivery.
An aortic dissection is a tear in the inner layer of the aorta, causing blood to flow between the layers of the aortic wall causing a life-threatening emergency.
Consulting locations
WOLLONGONG
Artery and Vein Clinic
402 Crown St
Wollongong
NSW 2500
GREGORY HILLS
Artery and Vein Clinic
Soma Centre
Suite 8/7, Gregory Hills drive
Gregory hills
NSW 2557
Orange
Artery and Vein Clinic
117 Molder st
Orange
NSW 2800
Contact Info
Wollongong
Phone: (02) 4226 9333
Fax: (02) 4229 4006
Gregory Hills
Phone: (02) 4601 1055
Fax: (02) 4601 1058
Orange
Phone: (02) 4601 1055
Fax: (02) 4601 1058
Healthlink EDI: wgvascul
Office Hours
9am – 4:30pm Monday to Friday
Phone Hours
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