Venous Ulcer

  • Himanshu Verma
  • Ramesh K. Tripathi


Chronic wounds in legs associated with clinical and radiological findings of chronic venous insufficiency are termed as venous ulcers. Venous ulcers are one of the most common types of leg ulcers. Different studies have reported its prevalence ranging from 0.7 to 2.4 %, which further increases with ageing population [1, 2]. Typically venous ulcers are recurrent in nature and therefore have a huge impact in treatment cost. In the United States, annual cost of venous ulcer treatment is over 2.5 billion dollars a year, and the annual estimated cost in the United Kingdom is 300–600 million pounds [3, 4].


Iliac Vein Great Saphenous Vein Venous Ulcer Chronic Venous Insufficiency Compression Therapy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Rabe E, Pannier-Fischer F, Bromen K, et al. Bonner Venenstudie der DeutschenGesellschaftfürPhlebologieepidemiologischeUntersuchungzurFrage der Häufigkeit und Ausprägung von chronischenVenenkrankheiten in der städtischen und ländlichenWohnbevölkerung. Phlebologie. 2003;32:1–14.Google Scholar
  2. 2.
    Fischer H. Venenleiden-EinerepräsentativeUntersuchung in der Bundesrepublik Deutschland (TübingerStudie). München: Urban und Schwarzenberg; 1981.Google Scholar
  3. 3.
    Simka M, Majewski E. The social and economic burden of venous leg ulcers: focus on the role of micronized purified flavonoid fraction adjuvant therapy. Am J Clin Dermatol. 2003;4(8):573–81.CrossRefPubMedGoogle Scholar
  4. 4.
    Nelzen O. Leq ulcers: economic aspects. Cost effectiveness analysis of leg ulcers. Phlebology. 2000;15:110–4.CrossRefGoogle Scholar
  5. 5.
    O’Donnell TF Jr, Passman MA, Marston WA, Ennis WJ, Dalsing M, Kistner RL, Lurie F, Henke PK, Gloviczki ML, et al. Society for Vascular Surgery; American Venous Forum. Management of venous leg ulcers: clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg. 2014;60(2 Suppl):3S–59.Google Scholar
  6. 6.
    Meissner MH, et al. The hemodynamics and diagnosis of venous disease. J Vasc Surg. 2007;46:4S–24.CrossRefPubMedGoogle Scholar
  7. 7.
    Pollack AA, et al. Venous pressure in the saphenous vein at the ankle in man during exercise and changes in posture. J Appl Physiol. 1949;1:649–62.PubMedGoogle Scholar
  8. 8.
    Burnand KG, et al. Pericapillary fibrin in the ulcer-bearing skin of the leg: the cause of lipodermatosclerosis and venous ulceration. BMJ. 1982;285:1071–2.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Falanga V, et al. The “trap” hypothesis of venous ulceration. Lancet. 1993;341:1006–8.CrossRefPubMedGoogle Scholar
  10. 10.
    Coleridge Smith PD, et al. Causes of venous ulceration: a new hypothesis. BMJ. 1988;296:1726–7.CrossRefPubMedGoogle Scholar
  11. 11.
    Abbade LP, Lastória S, Rollo Hde A. Venous ulcer: clinical characteristics and risk factors. Int J Dermatol. 2011;50(4):405–11.CrossRefPubMedGoogle Scholar
  12. 12.
    Jones J, Barr W, Robinson J, Carlisle C. Depression in patients with chronic venous ulceration. Br J Nurs. 2006;15(11):S17–23.CrossRefPubMedGoogle Scholar
  13. 13.
    Spentzouris G, Labropoulos N. The evaluation of lower-extremity ulcers. Semin Interv Radiol. 2009;26(4):286–95.CrossRefGoogle Scholar
  14. 14.
    Ruckley CV, Evans CJ, Allan PL, Lee AJ, Fowkes FG. Chronic venous insufficiency: clinical and duplex correlations. The Edinburgh Vein Study of venous disorders in the general population. J Vasc Surg. 2002;36(3):520–5.CrossRefPubMedGoogle Scholar
  15. 15.
    Labropoulos N, et al. Definition of venous reflux in the lower-extremity veins. J Vasc Surg. 2003;38:793–8.CrossRefPubMedGoogle Scholar
  16. 16.
    Neglen P, et al. Hemodynamic and clinical impact of ultrasound-derived venous reflux parameters. J Vasc Surg. 2004;40:303–10.CrossRefPubMedGoogle Scholar
  17. 17.
    Lurie F, et al. Multicenter assessment of venous reflux by duplex ultrasound. J Vasc Surg. 2012;55:437–45.CrossRefPubMedGoogle Scholar
  18. 18.
    Markel A, et al. A comparison of the cuff deflation method with valsava’s maneuver and limb compression in detecting venous valvular reflux. Arch Surg. 1994;129:701–5.CrossRefPubMedGoogle Scholar
  19. 19.
    Nicolaides AN, et al. Photoplethysmography in the assessment of venous insufficiency. J Vasc Surg. 1987;5:405–12.CrossRefPubMedGoogle Scholar
  20. 20.
    Abramowitz HB, et al. The use of photoplethsmography in the assessment of venous insufficiency: a comparison to venous pressure measurements. Surgery. 1979;86:434–41.PubMedGoogle Scholar
  21. 21.
    Criado E, et al. The role of air plethysmography in the diagnosis of chronic venous insufficiency. J Vasc Surg. 1998;27:660–70.CrossRefPubMedGoogle Scholar
  22. 22.
    Shiraishi Y. Relationship between arterial inflow rate and venous filling index of the lower extremities assessed by air plethysmography in subjects with or without axial reflux in the great saphenous vein. Ann Vasc Dis. 2014;7(3):306–11.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Arnoldussen CW, de Graaf R, Wittens CH, de Haan MW. Value of magnetic resonance venography and computed tomographic venography in lower extremity chronic venous disease. Phlebology. 2013;28((Suppl 1)):169–75.CrossRefPubMedGoogle Scholar
  24. 24.
    May R, Thurner J. The cause of the predominantly sinistral occurrence of thrombosis of the pelvic veins. Angiology. 1957;8:419–27.CrossRefPubMedGoogle Scholar
  25. 25.
    Negus D, Fletcher EW, Cockett FB, Thomas ML. Compression and band formation at the mouth of the left common iliac vein. Br J Surg. 1968;55:369–74.CrossRefPubMedGoogle Scholar
  26. 26.
    Raju S, Neglen P. High prevalence of nonthrombotic iliac vein lesions in chronic venous disease: a permissive role in pathogenicity. J Vasc Surg. 2006;44(1):136–43.CrossRefPubMedGoogle Scholar
  27. 27.
    Kistner RL, Ferris EB, Randhawa G, Kamida C. A method of performing descending venography. J Vasc Surg. 1986;4(5):464–8.CrossRefPubMedGoogle Scholar
  28. 28.
    Neglén P, Raju S. Intravascular ultrasound scan evaluation of the obstructed vein. J Vasc Surg. 2002;35(4):694–700.CrossRefPubMedGoogle Scholar
  29. 29.
    Raju S, Kirk OK, Jones TL. Endovenous management of venous leg ulcers. J Vas Surg: Venous Lymp Disordrs. 2013;1(2):165–72.Google Scholar
  30. 30.
    Heinen MM, van der Vleuten C, Uden CJ, de Rooij MJ, Evers AW, van Achterberg T. Physical activity and adherence to compression therapy in patients with venous leg ulcers. Arch Dermatol. 2007;143:1283–8.CrossRefPubMedGoogle Scholar
  31. 31.
    O’Meara S, Cullum N, Nelson EA, Dumville JC. Compression for venous leg ulcers. Cochrane Database Syst Rev. 2012;(11): CD000265.Google Scholar
  32. 32.
    Partsch H, Clark M, Mosti G, Steinlechner E, Schuren J, Abel M, et al. Classification of compression bandages: practical aspects. Dermatol Surg. 2008;34:600–9.PubMedGoogle Scholar
  33. 33.
    O’Donnell Jr TF, Passman MA, Marston WA, Ennis WJ, Dalsing M, Kistner RL, Lurie F, Society for Vascular Surgery; American Venous Forum, et al. Management of venous leg ulcers: clinical practice guidelines of The Society for Vascular Surgery ® and the American Venous Forum. J Vasc Surg. 2014;60(2 Suppl):3S–59.CrossRefPubMedGoogle Scholar
  34. 34.
    Rodeheaver GT. Wound cleansing, wound irrigation, wound disinfection. In: Krasner D, Kane D, editors. Chronic wound care: a clinical source book for healthcare professionals. Wayne: Health Management Publications; 1997. p. 97–108.Google Scholar
  35. 35.
    Sarin S, Scurr JH, Coleridge Smith PDC. Assessment of stripping the long saphenous vein in the treatment of primary varicose veins. Br J Surg. 1992;79:889–93.CrossRefPubMedGoogle Scholar
  36. 36.
    De Roos KP, Neumann HA. Muller’s ambulatory phlebectomy for varicose veins of the foot. Dermatol Surg. 1998;24(4):465–70.CrossRefPubMedGoogle Scholar
  37. 37.
    Johnson CM, McLafferty RB. Endovenous laser ablation of varicose veins: review of current technologies and clinical outcome. Vascular. 2007;15(5):250–4.CrossRefPubMedGoogle Scholar
  38. 38.
    Biemans AA, Kockaert M, Akkersdijk GP, van den Bos RR, de Maeseneer MG, Cuypers P, et al. Comparing endovenous laser ablation, foam sclerotherapy, and conventional surgery for great saphenous varicose veins. J Vasc Surg. 2013;58(3):727–34.CrossRefPubMedGoogle Scholar
  39. 39.
    Nesbitt C, Eifell RK, Coyne P, Badri H, Bhattacharya V, Stansby G. Endovenous ablation (radiofrequency and laser) and foam sclerotherapy versus conventional surgery for great saphenous vein varices. Cochrane Database Syst Rev. 2011;(10):CD005624.Google Scholar
  40. 40.
    Gibson KD, Ferris BL, Polissar N, et al. Endovenous laser treatment of the short saphenous vein: efficacy and complications. J Vasc Surg. 2007;45:795–801.CrossRefPubMedGoogle Scholar
  41. 41.
    Masuda EM, Kistner RL. Long-term results of venous valve reconstruction: a four- to twenty-one-year follow-up. J Vasc Surg. 1994;19:391–403.CrossRefPubMedGoogle Scholar
  42. 42.
    Neglén P, et al. Stenting of the venous outflow in chronic venous disease: long-term stent-related outcome, clinical, and hemodynamic result. J Vasc Surg. 2007;46:979–90.CrossRefPubMedGoogle Scholar
  43. 43.
    Raju S, Fredericks R. Valve reconstruction procedures for nonobstructive venous insufficiency: rationale, techniques, and results in 107 procedures with two- to eight-year follow-up. J Vasc Surg. 1988;7:301–10.CrossRefPubMedGoogle Scholar
  44. 44.
    Perrin M. Reconstructive surgery for deep venous reflux: a report on 144 cases. Cardiovasc Surg. 2000;8:246–55.CrossRefPubMedGoogle Scholar
  45. 45.
    Tripathi R, Sieunarine K, Abbas M, Durrani N. Deep venous valve reconstruction for non-healing leg ulcers: techniques and results. ANZ J Surg. 2004;74:34–9.CrossRefPubMedGoogle Scholar
  46. 46.
    Verma H, Rajesh S, Tripathi R. Reduction internal valvuloplasty (RIVAL) is a new technical improvement on plication internal valvuloplasty for primary deep vein valvular incompetence. J Vasc Surg: Venous Lymp Dis. 2014;2:383–9.Google Scholar
  47. 47.
    Reeder SWI, Céline E, BirgitteMaessen-Visch M, Kees-Peter de Roos HA, Martino N. Recurrence of venous leg ulceration. Rev Vasc Med. 2013;1(4):63–5.CrossRefGoogle Scholar
  48. 48.
    McDaniel HB, Marston WA, Farber MA, Mendes RR, Owens LV, Young ML, Daniel PF, Keagy BA. Recurrence of chronic venous ulcers on the basis of clinical, etiologic, anatomic, and pathophysiologic criteria and air plethysmography. J Vasc Surg. 2002;35(4):723–8.CrossRefPubMedGoogle Scholar
  49. 49.
    Herman RJ, Neiman HL, Yao JS, et al. Descending venography: a method of evaluating lower extremity venous valvular function. Radiology. 1980;137:63–9.CrossRefPubMedGoogle Scholar

Copyright information

© Springer India 2016

Authors and Affiliations

  1. 1.Department of Vascular SurgeryNarayan Institute of Vascular SciencesBangaloreIndia
  2. 2.Department of Vascular and Endovascular SurgeryNarayan Institute of Vascular Sciences HealthcareBangaloreIndia

Personalised recommendations