Venous ulcers develop when blood flow is seriously impaired in the major veins of the leg. They typically form on the back of the lower leg between the mid-calf and the ankle bone, and are usually accompanied by skin discoloration, skin hardening, itchiness, and leg pain.
The goal of venous ulcer treatment is to restore healthy flow to the veins. While less severe vein disease can usually be addressed with superficial vein closure, venous ulcers often have deep vein obstructions that must be addressed as well to allow the leg to heal. Venous ulcer treatment at Interventional and Vascular Care in Dallas, Texas is provided by a Vascular Specialist that is trained in superficial vein closure and deep vein revascularization.
If you suspect that your leg ulcers are vein-related, but haven't received a formal diagnosis, you can review your symptoms and risk factors here.
Vein Ulcer Treatment
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Venous Ulcer Treatment Dallas Texas
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"Dr. Fritts gave me all the time I needed to understand & feel comfortable with the procedure. I am extremely grateful for his caring, gentle and highly competent care in a situation that has felt frightening and anonymous. He has a healer’s way about him. Highest recommendation."
-- Rod in Dallas, TX
Venous Ulcer Treatment in Dallas, TX
Dr. Aaron Fritts, MD
Interventional & Vascular Specialist
Dr. Aaron Fritts is a board-certified Vascular & Interventional Radiologist that specializes in minimally invasive venous ulcer treatment in Dallas, Texas. Dr. Fritts is well-versed in vascular conditions, and has found passion in providing minimally invasive treatment for individuals suffering from serious vein disease. He was recently selected as a SuperDoctors Rising Star and has been voted one of D-Magazine's best doctors in Dallas.
Living With Venous Leg Ulcers
Venous ulcers are the most severe manifestation of a condition called chronic venous insufficiency. Venous insufficiency is a broad term in medicine that is used to describe any vein abnormality that causes insufficient blood through the veins of the leg.
In its least severe form, venous insufficiency can cause medically insignificant spider veins, but as the disease progresses, varicose veins may develop and the affected leg(s) may become swollen and painful. As more veins are affected and blood flow is further compromised, the lower half of the leg can undergo major changes in appearance and ulcers can develop. In most individuals with venous insufficiency this disease process takes place over several years, and many cases aren't symptomatic until later stages of disease.
Deep and Superficial Veins - When we talk about veins in the legs, we tend to talk about them in two categories: deep and superficial. The deep veins sit deep within the leg, and are the main channel by which blood travels from the legs back to the heart. On the other hand, superficial veins run closer to the surface of the leg and drain blood into the deep veins. The superficial veins can be seen as bulging varicose veins in the early stages of venous insufficiency.
Deep and superficial veins are connected by deep-superficial junctions and perforator veins. This connectivity is important because flow problems in the deep veins can cause flow problems in the superficial veins and vise versa.
There are multiple ways in which venous insufficiency can develop, and venous ulcers are often the manifestation of multiple sources of venous insufficiency.
Reflux - Vein reflux is a medical phrase that is used to describe when blood flows backwards in a vein. Healthy veins have one-way valves that prevent back flow, but when these valves fail, blood accumulates in the affected vein, increasing pressure and stifling flow. Reflux is the cause of most cases of varicose veins, but can occur in deep veins as well.
Compression - Vein anatomy differs from person to person. In some individuals, major veins are compressed by nearby anatomical structures. This increases pressure and obstructs blood flow.
May-Thurner syndrome, also referred to as iliocaval venous compression syndrome or iliac vein compression syndrome, is one such condition in which a major artery presses a major vein against a bony structure in the groin area. In a similar way, obesity is thought to cause venous insufficiency by compressing major veins in the abdominal region.
Obstruction - Because veins are low-flow, low-pressure vessels, they are susceptible to the formation of blood clots (thrombus) that obstruct flow. Clots can develop in both superficial and deep veins (deep vein thrombosis). Clots are often more serious in deep veins, especially when they form above the knee. If left untreated, clots in the veins harden into permanent obstructions, causing blood flow challenges throughout the veins.
Post Thrombotic Syndrome - In the last decade or so, vascular specialists have found that venous insufficiency can persist even after the successful treatment of deep vein thrombosis. The presence of thrombus is thought to instigate a chronic inflammatory response that compromises the integrity of the veins over time.
Venous Ulcer Symptoms
The lower leg undergoes major changes when venous insufficiency gets serious:
Ulcer - usually forms between the mid-calf and the ankle bone
Skin color changes - red-brown coloration or whitening of the leg can occur
Eczema - parts of the skin become red and itchy
Lipodermatosclerosis - the skin becomes tough and inflexible
Venous insufficiency causes blood to pool in the veins and leak into surrounding tissues, causing:
Edema - the leg becomes swollen with fluid
Varicose veins - swollen, bulging veins coursing along the surface of the leg
Heaviness - swelling can make the legs feel heavy
Fatigue especially when active
Venous insufficiency can cause a variety of pain patterns:
Leg cramps, especially at night
Claudication - thigh / leg pain and tightness when exercising
Aching, soreness, or burning throughout the leg
Venous ulcer pain
Venous Ulcer Risk Factors
Age | the older you get, the more likely you are to develop a venous ulcer
Gender | women are more likely than men to be diagnosed with venous insufficiency, but venous ulcers occur at similar rates in both men and women
Lifestyle or Occupation | extended periods of sitting, standing, or low mobility are thought to contribute to venous insufficiency
Obesity | vein compression in the abdomen may increase your risk of venous insufficiency and ulceration
Family History | venous insufficiency may run in your family
Smoking | smoking has been shown to increase the risk of venous insufficiency
A simple ultrasound exam is the first step to verify if your ulcers are caused by clinically significant venous insufficiency. More advanced imaging techniques, such as venogram and intravascular ultrasound, may be necessary to assess more complex vein pathologies.
IVC is a fully staffed medical imaging and treatment center that can help you confirm if your veins are causing your ulcer. Give us a call today to book your consultation for venous ulcer management and treatment.
Venous Ulcer Treatment
The root cause of a venous ulcer is severely insufficient blood flow in the veins of the leg. For this reason, venous ulcers are often referred to as 'venous stasis ulcers,' and treatment strategies are focused on improving blood flow throughout the venous system. In many cases, both superficial and deep vein problems must be addressed to fully heal the leg.
When you see a Vascular Specialist, the goal of venous ulcer treatment is to 'close down' superficial vein disease, and to 'open up' deep vein disease. The idea here is to improve blood flow through the deep veins and to improve circulation in the superficial veins by re-routing blood flow through healthy veins nearby. Although these two treatments require different tools and very different approaches, they can both be performed by a Vascular Specialist using image-guided, minimally invasive techniques.
Superficial Vein Closure
Superficial vein closure is the gold standard to treat varicose veins that are contributing to venous ulceration. The phrase 'superficial vein closure' describes a variety of minimally invasive treatments that are used to close down varicose veins. This can be done by applying thermal energy, a specially formulated chemical irritant, or glue to the inside of the vein. Regardless of which treatment is used, this is a catheter-based, outpatient procedure that is performed through a single tiny puncture in the leg.
Deep Vein Revascularization
Deep vein revascularization is an image-guided procedure in which blood flow obstructions in the deep veins are opened up to improve blood flow and circulation. Flow obstructions can be caused by venous reflux, extrinsic compression, a blood clot, or chronic occlusion. A few different techniques are used by a Vascular Specialist to address these unique pathologies:
Angioplasty | a balloon device is positioned along the length of the obstructed vein and inflated, forcing the obstruction to open
Stenting | a tubular support device made out of a special metal or polymer is placed along the length of the deep vein obstruction and left in the vein to help it stay open after the procedure.
Thrombectomy | a mechanical device is used to remove clot or chronic occlusion from a deep vein.
Advantages of Minimally Invasive Venous Ulcer Treatment
Venous Ulcer Treatment: superficial vein reflux is treated with vein closure, and obstructed or compressed deep veins are treated with deep vein revascularization to restore healthy circulation.
Superficial vein closure and deep vein revascularization are performed through a single puncture in the leg. Unlike major surgery, there's no cutting, which means minimal trauma and faster recovery time.
Treatment is performed under the guidance of imaging. This allows your doctor to safely provide therapy directly to the veins that need it with minimal risk of side effects.
Venous Ulcer Treatment
A skilled Vascular Specialist can successfully treat superficial and deep vein pathologies, providing your legs with the best opportunity to heal.
Heal Your Legs
Treatment restores healthy blood flow throughout the veins of the leg, allowing venous ulcers to heal.
Restoring healthy circulation takes the fluid off of your leg, so you can get back on your feet
Treatment can help relieve cramps, claudication, and soreness in the leg caused by insufficient blood flow.
Compare Venous Ulcer Treatment Options
Compression stockings are usually prescribed by general practitioners as a first-line therapy for venous insufficiency. They can help relieve symptoms by improving blood flow through the veins. This improvement in blood flow does not address the underlying pathologies involved in venous ulcers, so continuous long-term use is required for stockings to be effective. It's well understood that many patients have trouble staying compliant with their stocking prescription, which can render them ineffective.
Wound care consists of self-care techniques, special dressings / bandages, and lifestyle adjustments that keep the venous ulcer clean and promote healing of the skin. While wound care does not address the underlying vein problems that cause venous ulcers, wound care is an essential part of healing and should be continued when other treatments are pursued.
Vein Stripping Surgery
Vein stripping is a more invasive surgical alternative to superficial vein closure. This procedure is used to remove a superficial vein by threading a wire device through it and ripping the vein out. Vein stripping typically requires a major incisions at each end of the vein to access it and prep it for removal.
Deep Vein Bypass Surgery
Surgical bypass may be an appropriate treatment option in the case of a serious deep vein obstruction. Bypass surgery works by connecting a new vessel (a graft) from where sufficient flow is present to a section of the leg where it is absent. The new vessel may be a prosthetic or a major blood vessel from the patient or a donor.
Superficial vein closure and deep vein revascularization do not require any major incisions. These procedures are done by an Interventional & Vascular Specialist using small tubes and wires.
Venous Ulcer Treatment Options
Vein Stripping Surgery
Superficial Vein Closure
Minimally invasive procedure; recommended treatment for symptomatic superficial varicose veins contributing to venous ulcers.
Usually prescribed as a first-line therapy for venous insufficiency; stockings can help improve venous ulcer symptoms but require continuous use to be effective.
Major surgery; may be recommended when deep vein revascularization is not possible and/or certain veins are affected.
More invasive surgical alternative to superficial vein closure; vein stripping has been shown to require longer recovery time and has a higher risk of procedural complications than superficial vein closure.
Prescribed to keep ulcers clean and promote healing of the skin; wound care complements other treatments and should be continued to maximize healing.
Deep Vein Revascularization
Minimally invasive procedure; used to address deep vein pathologies, including venous reflux, extrinsic compression, blood clot, or chronic occlusion
Stubborn venous ulcers that won't heal? We treat the source. A vascular specialist can treat your venous ulcer and help you keep your legs healthy. Give us a call to book your consultation today! We look forward to hearing from you.
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 Cesarone (2002). ‘Real’ epidemiology of varicose veins and chronic venous diseases: the San Valentino Vascular Screening Project. Angiology 2002; 53: 119–130.
 Meissner (2016). What is effective care for varicose veins? Phlebology, 31(1_suppl), 80–87.
 Gohel (2018). A Randomized Trial of Early Endovenous Ablation in Venous Ulceration. New England Journal of Medicine, 378(22), 2105–2114.
 Kankam (2017). A summation analysis of compliance and complications of compression hosiery for patients with chronic venous disease or post-thrombotic syndrome. European Journal of Vascular and Endovascular Surgery, 55:406-416.
 Lohr (2010). Radiofrequency Ablation: Evolution of a Treatment. Seminars in Vascular Surgery, 23(2), 90–100.
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