Chapter 21: Chronic Venous Insufficiency and Leg Ulceration

The following sections are included:

• Clinical signs of chronic venous insufficiency (CVI) include swelling, venous eczema, pigmentation, lipodermatosclerosis and ulceration.

• The main area for venous change and ulceration is the medial calf “gaiter” area.

• The mechanisms involved are venous reflux, outflow obstruction and calf pump failure or a combination of these.

• Many cases (c. 50%) follow DVT when they are termed the postthrombotic syndrome.

• Multi-layered compression bandaging is the gold standard for healing venous ulceration.

• Graduated compression stockings are used to maintain healing.

• All venous ulcer patients should be referred for a duplex scan.

• Those with superficial venous incompetence should be offered surgical intervention.

• Graduated compression is contraindicated in the presence of significant peripheral arterial disease.

• Venous reconstruction is rarely performed, but there remains a role for venous bypass surgery for deep venous obstruction.

• The use of deep venous angioplasty and stenting is increasing and has good results in selected patients.