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Prevention and treatment

Venous and arterial leg ulcers

About 80 percent of chronic wounds localized on the lower leg are the result of chronic venous insufficiency, while the cause is an arterial etiology in 5-10 percent of cases. Other etiologies, such as neuropathic ulcers account for the remaining percentage.(1) Leg ulcers affect approximately 1 in 1,000 people in Europe(2) and are more frequent in elderly people: The average age of people with venous leg ulcers is approximately 73.5 years.(3)

 

 

Venous leg ulcers

The cause of venous leg ulcers is venous insufficiency due to damage to the valves leading to hypertension, retrograde blood flow, and/or obstruction in the calf veins. All this may be responsible for any dermatological and vascular complications.

 

Venous leg ulcers can be painless, but some are very painful. They can become infected as well. There is often an inflammation (dermatitis) around the infected venous leg ulcer.(4)

  • own history of venous leg ulcer
  • history of deep vein thrombosis and or varicose veins
  • advanced age
  • family history of venous leg ulcer

Prevention and intensive management are key in venous leg ulcer treatment, especially since the recurrence rate of up to 17 percent within one year is challenging. For this reason, numerous guidelines have been developed, but unfortunately some heterogeneity exists. Nevertheless, consensus could be reached in most cases:

 

  • Use a multidisciplinary approach involving healthcare experts such as vascular surgeons, angiologists, primary care physicians, and nurses.
  • Take a detailed history and perform a comprehensive physical examination.
  • Perform compression therapy, topical treatments, dressings, antimicrobials.(5,6,7)

1. Situm M, Kolić M, Redzepi G, Antolić S. Kronicne rane kao javnozdravstveni problem [Chronic wounds as a public health problem]. Acta Med Croatica. 2014 Oct;68 Suppl 15-7. Croatian. PMID 25326983.

2. Petherick ES, Pickett KE, Cullum NA. Can different primary care databases produce comparable estimates of burden of disease: results of a study exploring venous leg ulceration. Fam Pract. 2015 Aug;32(4):374-80. doi: 10.1093/fampra/cmv013. Epub 2015 May 1. PMID: 25934977; PMCID: PMC5942540.

3. Urwin S, Dumville JC, Sutton M, Cullum N. Health service costs of treating venous leg ulcers in the UK: evidence from a cross-sectional survey based in the north west of England. BMJ Open. 2022 Jan 6;12(1):e056790. doi: 10.1136/bmjopen-2021-056790. PMID: 34992123; PMCID: PMC8739075.

4. Robles-Tenorio A, Lev-Tov H, Ocampo-Candiani J. Venous Leg Ulcer. 2022 Sep 18. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan–. PMID: 33620871

5. Tan MKH, Luo R, Onida S, Maccatrozzo S, Davies AH. Venous Leg Ulcer Clinical Practice Guidelines: What is AGREEd? Eur J Vasc Endovasc Surg. 2019 Jan;57(1):121-129. doi: 10.1016/j.ejvs.2018.08.043. Epub 2018 Oct 2. PMID: 30287207.

6. Gohel MS, Taylor M, Earnshaw JJ, Heather BP, Poskitt KR, Whyman MR. Risk factors for delayed healing and recurrence of chronic venous leg ulcers--an analysis of 1324 legs. Eur J Vasc Endovasc Surg. 2005 Jan;29(1):74-7. doi: 10.1016/j.ejvs.2004.10.002. PMID: 15570275.

7. Maccatrozzo S, Onida S, Davies AH. Guidelines on venous ulceration: A mess. Phlebology. 2017 Jul;32(6):369-370. doi: 10.1177/0268355516657686. Epub 2016 Jun 30. PMID: 27364908.01312.

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