Materiały źródłowe

• #1 Venous Ulcers: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0901/p298.html

  Venous ulcers are the most common type of chronic lower extremity ulcers, affecting 1% to 3% of the U.S. population. […] Venous ulcers are open skin lesions that occur in an area affected by venous hypertension.1 The prevalence of venous ulcers in the United States ranges from 1% to 3%.2,3 […] Initial noninvasive imaging with comprehensive venous duplex ultrasonography, arterial pulse examination, and measurement of ankle-brachial index is recommended for all patients with suspected venous ulcers.1 Color duplex ultrasonography is recommended to assess for deep and superficial venous reflux and obstruction.1,15 Because standard therapy for venous ulcers can be harmful in patients with ischemia, additional ultrasound evaluation to assess arterial blood flow is indicated when the ankle-brachial index is abnormal and in the presence of certain comorbid conditions such as diabetes mellitus, chronic kidney disease, or other conditions that lead to vascular calcification.1 Further evaluation with biopsy or referral to a subspecialist is warranted if ulcer healing stalls or the ulcer has an atypical appearance.1,5

• #2 Venous Ulcers: Diagnosis and Treatment – PubMed

  https://pubmed.ncbi.nlm.nih.gov/31478635/

  Venous ulcers are the most common type of chronic lower extremity ulcers, affecting 1% to 3% of the U.S. population. Venous hypertension as a result of venous reflux (incompetence) or obstruction is thought to be the primary underlying mechanism for venous ulcer formation. Risk factors for the development of venous ulcers include age 55 years or older, family history of chronic venous insufficiency, higher body mass index, history of pulmonary embolism or superficial/deep venous thrombosis, lower extremity skeletal or joint disease, higher number of pregnancies, parental history of ankle ulcers, physical inactivity, history of ulcers, severe lipodermatosclerosis, and venous reflux in deep veins. […] Poor prognostic signs for healing include ulcer duration longer than three months, initial ulcer length of 10 cm or more, presence of lower limb arterial disease, advanced age, and elevated body mass index. On physical examination, venous ulcers are generally irregular and shallow with well-defined borders and are often located over bony prominences. Signs of venous disease, such as varicose veins, edema, or venous dermatitis, may be present. Other associated findings include telangiectasias, corona phlebectatica, atrophie blanche, lipodermatosclerosis, and inverted champagne-bottle deformity of the lower leg. Chronic venous ulcers significantly impact quality of life. Severe complications include infection and malignant change. Current evidence supports treatment of venous ulcers with compression therapy, exercise, dressings, pentoxifylline, and tissue products. Referral to a wound subspecialist should be considered for ulcers that are large, of prolonged duration, or refractory to conservative measures. Early venous ablation and surgical intervention to correct superficial venous reflux can improve healing and decrease recurrence rates.

• #3 Optimal Diagnosis and Therapy of Venous Ulcer

  https://www.annphlebology.org/journal/view.html?pn=search&uid=134&vmd=Full

  Venous ulcer, a condition caused by chronic venous disorder, is the most common form of leg ulcer, accounting for approximately 70% of all leg ulcer cases. […] The diagnosis of venous ulcer is based mostly on medical history, clinical presentations, and physical examination. […] Duplex ultrasonography is the most commonly used method for diagnosing chronic venous insufficiency (CVI) and assessing its causes. […] The diagnosis of VLU is based mostly on medical history, clinical presentations, and physical examination. Detailed history taking and physical examination enable differentiation of leg ulcer due to other causes. […] Venous leg ulcer is caused by venous lesions, such as venous reflux or obstruction, and thus, accurate diagnosis of comorbid venous disorder is very important for future treatment.

• #4 Diagnosis and Treatment of Venous Ulcers | AAFP

  https://www.aafp.org/pubs/afp/issues/2010/0415/p989.html

  Venous ulcer, also known as stasis ulcer, is the most common etiology of lower extremity ulceration, affecting approximately 1 percent of the U.S. population. […] The diagnosis of venous ulcers is generally clinical; however, tests such as ankle-brachial index, color duplex ultrasonography, plethysmography, and venography may be helpful if the diagnosis is unclear. […] Determining etiology is a critical step in the management of venous ulcers. […] On physical examination, venous ulcers are generally irregular and shallow. Granulation tissue and fibrin are often present in the ulcer base. […] A clinical severity score based on the CEAP (clinical, etiology, anatomy, and pathophysiology) classification system can guide the assessment of chronic venous disorders. […] Poor prognostic factors for venous ulcers include large size and prolonged duration.

• #5 Venous Ulcers: Diagnosis and Treatment – PubMed

  https://pubmed.ncbi.nlm.nih.gov/31478635/

  Venous ulcers are the most common type of chronic lower extremity ulcers, affecting 1% to 3% of the U.S. population. Venous hypertension as a result of venous reflux (incompetence) or obstruction is thought to be the primary underlying mechanism for venous ulcer formation. Risk factors for the development of venous ulcers include age 55 years or older, family history of chronic venous insufficiency, higher body mass index, history of pulmonary embolism or superficial/deep venous thrombosis, lower extremity skeletal or joint disease, higher number of pregnancies, parental history of ankle ulcers, physical inactivity, history of ulcers, severe lipodermatosclerosis, and venous reflux in deep veins. […] Poor prognostic signs for healing include ulcer duration longer than three months, initial ulcer length of 10 cm or more, presence of lower limb arterial disease, advanced age, and elevated body mass index. On physical examination, venous ulcers are generally irregular and shallow with well-defined borders and are often located over bony prominences. Signs of venous disease, such as varicose veins, edema, or venous dermatitis, may be present. Other associated findings include telangiectasias, corona phlebectatica, atrophie blanche, lipodermatosclerosis, and inverted champagne-bottle deformity of the lower leg. Chronic venous ulcers significantly impact quality of life. Severe complications include infection and malignant change. Current evidence supports treatment of venous ulcers with compression therapy, exercise, dressings, pentoxifylline, and tissue products. Referral to a wound subspecialist should be considered for ulcers that are large, of prolonged duration, or refractory to conservative measures. Early venous ablation and surgical intervention to correct superficial venous reflux can improve healing and decrease recurrence rates.

• #6 Venous leg ulcer | NHS inform

  https://www.nhsinform.scot/illnesses-and-conditions/skin-hair-and-nails/venous-leg-ulcer/

  Speak to your GP practice if you think you have a venous leg ulcer. The ulcer is unlikely to heal without specialist treatment. […] They will discuss your symptoms and examine the affected leg to help diagnose a venous leg ulcer. However, they may also need to do some other tests. […] Your GP or practice nurse will ask whether you have any other symptoms associated with venous leg ulcers, including: swelling in your ankles, discoloured or hard skin. […] Theyll try to work out the cause of the ulcer by asking about underlying conditions or previous injuries, such as: diabetes, deep vein thrombosis (DVT), injury or surgery in the affected leg, a previous leg ulcer. […] Theyll also examine your leg when youre standing up and lying down. […] Theyll also feel your pulse at your ankles to make sure the arteries in your leg are working properly.

• #7

  https://www2.hse.ie/conditions/venous-leg-ulcer/diagnosis/

  See your GP if you think you have a venous leg ulcer. The ulcer is unlikely to heal without specialist treatment. […] Diagnosis is largely based on your symptoms and examination of your affected leg. Sometimes more tests may be needed. […] Your GP or practice nurse will ask if you have any other symptoms associated with venous leg ulcers, such as: swelling in your ankles, discoloured or hard skin. […] Your GP or practice nurse will try to find the cause of the ulcer by asking about underlying conditions or previous injuries, such as: diabetes, deep vein thrombosis (DVT), injury or surgery in the affected leg, a previous leg ulcer. […] They’ll also examine your leg, both when you’re standing up and lying down for: varicose veins, discoloured or hard skin, pulses at your ankles, ankle swelling.

• #8 Venous Ulcers: Diagnosis and Treatment – PubMed

  https://pubmed.ncbi.nlm.nih.gov/31478635/

  Venous ulcers are the most common type of chronic lower extremity ulcers, affecting 1% to 3% of the U.S. population. Venous hypertension as a result of venous reflux (incompetence) or obstruction is thought to be the primary underlying mechanism for venous ulcer formation. Risk factors for the development of venous ulcers include age 55 years or older, family history of chronic venous insufficiency, higher body mass index, history of pulmonary embolism or superficial/deep venous thrombosis, lower extremity skeletal or joint disease, higher number of pregnancies, parental history of ankle ulcers, physical inactivity, history of ulcers, severe lipodermatosclerosis, and venous reflux in deep veins. […] Poor prognostic signs for healing include ulcer duration longer than three months, initial ulcer length of 10 cm or more, presence of lower limb arterial disease, advanced age, and elevated body mass index. On physical examination, venous ulcers are generally irregular and shallow with well-defined borders and are often located over bony prominences. Signs of venous disease, such as varicose veins, edema, or venous dermatitis, may be present. Other associated findings include telangiectasias, corona phlebectatica, atrophie blanche, lipodermatosclerosis, and inverted champagne-bottle deformity of the lower leg. Chronic venous ulcers significantly impact quality of life. Severe complications include infection and malignant change. Current evidence supports treatment of venous ulcers with compression therapy, exercise, dressings, pentoxifylline, and tissue products. Referral to a wound subspecialist should be considered for ulcers that are large, of prolonged duration, or refractory to conservative measures. Early venous ablation and surgical intervention to correct superficial venous reflux can improve healing and decrease recurrence rates.

• #9 Diagnosis and Treatment of Venous Ulcers | AAFP

  https://www.aafp.org/pubs/afp/issues/2010/0415/p989.html

  Venous ulcer, also known as stasis ulcer, is the most common etiology of lower extremity ulceration, affecting approximately 1 percent of the U.S. population. […] The diagnosis of venous ulcers is generally clinical; however, tests such as ankle-brachial index, color duplex ultrasonography, plethysmography, and venography may be helpful if the diagnosis is unclear. […] Determining etiology is a critical step in the management of venous ulcers. […] On physical examination, venous ulcers are generally irregular and shallow. Granulation tissue and fibrin are often present in the ulcer base. […] A clinical severity score based on the CEAP (clinical, etiology, anatomy, and pathophysiology) classification system can guide the assessment of chronic venous disorders. […] Poor prognostic factors for venous ulcers include large size and prolonged duration.

• #10 Venous Ulcers: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0901/p298.html

  Venous ulcers are the most common type of chronic lower extremity ulcers, affecting 1% to 3% of the U.S. population. […] Venous ulcers are open skin lesions that occur in an area affected by venous hypertension.1 The prevalence of venous ulcers in the United States ranges from 1% to 3%.2,3 […] Initial noninvasive imaging with comprehensive venous duplex ultrasonography, arterial pulse examination, and measurement of ankle-brachial index is recommended for all patients with suspected venous ulcers.1 Color duplex ultrasonography is recommended to assess for deep and superficial venous reflux and obstruction.1,15 Because standard therapy for venous ulcers can be harmful in patients with ischemia, additional ultrasound evaluation to assess arterial blood flow is indicated when the ankle-brachial index is abnormal and in the presence of certain comorbid conditions such as diabetes mellitus, chronic kidney disease, or other conditions that lead to vascular calcification.1 Further evaluation with biopsy or referral to a subspecialist is warranted if ulcer healing stalls or the ulcer has an atypical appearance.1,5

• #11 Optimal Diagnosis and Therapy of Venous Ulcer

  https://www.annphlebology.org/journal/view.html?pn=search&uid=134&vmd=Full

  Therefore, early non-invasive tests, including not just comprehensive duplex ultrasonography, but also arterial pulse examination and ankle-brachial index test, are recommended for all patients suspected of having venous ulcer. […] Specific findings suggestive of venous ulcer are location of the ulcer and associated findings. Venous ulcers typically occur in the lateral and medial malleolar regions of the ankle and are often accompanied by telangiectasia, corona phlebectatica, atrophic blanche, and lipodermatosclerosis. […] Although venous ulcer is the most common type of chronic leg ulcer among all leg ulcers, it must be differentiated from arterial occlusive disease, diabetic neuropathy, malignancy, pyoderma gangrenosum, and other inflammatory ulcers. […] For the diagnosis of CVI, a complete assessment of venous segments for reflux is needed for hemodynamic evaluation. […] Duplex ultrasonography is the test method most commonly used today for diagnosing CVI and assessing its etiology and anatomy. […] Reflux is diagnosed based on reflux time of 0.5 seconds in superficial veins and 1 second in deep veins.

• #12 Venous Ulcers: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0901/p298.html

  Venous ulcers are the most common type of chronic lower extremity ulcers, affecting 1% to 3% of the U.S. population. […] Venous ulcers are open skin lesions that occur in an area affected by venous hypertension.1 The prevalence of venous ulcers in the United States ranges from 1% to 3%.2,3 […] Initial noninvasive imaging with comprehensive venous duplex ultrasonography, arterial pulse examination, and measurement of ankle-brachial index is recommended for all patients with suspected venous ulcers.1 Color duplex ultrasonography is recommended to assess for deep and superficial venous reflux and obstruction.1,15 Because standard therapy for venous ulcers can be harmful in patients with ischemia, additional ultrasound evaluation to assess arterial blood flow is indicated when the ankle-brachial index is abnormal and in the presence of certain comorbid conditions such as diabetes mellitus, chronic kidney disease, or other conditions that lead to vascular calcification.1 Further evaluation with biopsy or referral to a subspecialist is warranted if ulcer healing stalls or the ulcer has an atypical appearance.1,5

• #13 Perspective Chapter: Diagnosis and Treatment of Venous Leg Ulcer | IntechOpen

  https://www.intechopen.com/chapters/82402

  Venous leg ulcer (VLU) represent a pathological tissue change in the form of a defect in the lower leg which occurs as a complication of chronic venous insufficiency. […] It is very important to have a comprehensive clinical examination at the very beginning. Subsequent non-invasive and sometimes invasive tests may be indicated for diagnosis and treatment planning. Inadequate diagnosis results in inadequate therapy. […] Today, the following diagnostic procedures are used to examine the venous system: Color-flow duplex ultrasound in the diagnosis of vascular diseases is widespread today, both because of its high sensitivity and accuracy, and the fact that it is a simple and safe diagnostic procedure. […] The success of the treatment of venous ulcers of the lower extremities depends on the accuracy of the diagnosis.

• #14 Optimal Diagnosis and Therapy of Venous Ulcer

  https://www.annphlebology.org/journal/view.html?pn=mostdownload&uid=134&vmd=Full

  Therefore, early non-invasive tests, including not just comprehensive duplex ultrasonography, but also arterial pulse examination and ankle-brachial index test, are recommended for all patients suspected of having venous ulcer. […] Venous ulcers typically occur in the lateral and medial malleolar regions of the ankle and are often accompanied by telangiectasia, corona phlebectatica, atrophic blanche, and lipodermatosclerosis. […] Duplex ultrasonography is the test method most commonly used today for diagnosing CVI and assessing its etiology and anatomy. […] Reflux is diagnosed based on reflux time of 0.5 seconds in superficial veins and 1 second in deep veins. However, although longer reflux time is typically observed in CVI, it is not always consistent with the clinical presentations.

• #15

  https://www.nhs.uk/conditions/leg-ulcer/diagnosis/

  See your GP if you think you have a venous leg ulcer. The ulcer is unlikely to heal without specialist treatment. […] Diagnosis is largely based on your symptoms and examination of your affected leg, although additional tests may be required. […] To rule out peripheral arterial disease (a condition affecting the arteries) as a possible cause of your symptoms, your GP or nurse will carry out a test known as a Doppler test. […] It’s important to carry out this test, as the main treatment for venous ulcers is compression bandages or stockings to improve the vein circulation in your legs. […] In some cases, your GP or nurse may decide to refer you to a specialist, such as a vascular specialist who treats conditions affecting the blood vessels. […] You may be referred to a vascular specialist if your GP or nurse is unsure about your diagnosis, or if they suspect your ulcer may be caused by artery diseases.

• #16 Venous leg ulcer | NHS inform

  https://www.nhsinform.scot/illnesses-and-conditions/skin-hair-and-nails/venous-leg-ulcer/

  You GP or nurse will carry out a test called the Doppler study. This helps to rule out peripheral arterial disease (a condition affecting the arteries). […] This involves measuring the blood pressure in the arteries at your ankles and comparing it to the pressure in your arms. If you have peripheral arterial disease, the blood pressure in your ankles will be lower than your arms. […] Its important to carry out this check as the main treatment for venous ulcers is compression bandages or stockings. This improves the vein circulation in your legs. Its not safe to apply compression if the ankle artery pressures are low. […] In some cases, your GP or nurse may decide to refer you to a specialist in conditions affecting the blood vessels (vascular specialist). […] The specialist will discuss your medical history and examine you. They may also need to arrange further investigations to plan your treatment.

• #17 Venous Ulcers: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0901/p298.html

  Venous ulcers are the most common type of chronic lower extremity ulcers, affecting 1% to 3% of the U.S. population. […] Venous ulcers are open skin lesions that occur in an area affected by venous hypertension.1 The prevalence of venous ulcers in the United States ranges from 1% to 3%.2,3 […] Initial noninvasive imaging with comprehensive venous duplex ultrasonography, arterial pulse examination, and measurement of ankle-brachial index is recommended for all patients with suspected venous ulcers.1 Color duplex ultrasonography is recommended to assess for deep and superficial venous reflux and obstruction.1,15 Because standard therapy for venous ulcers can be harmful in patients with ischemia, additional ultrasound evaluation to assess arterial blood flow is indicated when the ankle-brachial index is abnormal and in the presence of certain comorbid conditions such as diabetes mellitus, chronic kidney disease, or other conditions that lead to vascular calcification.1 Further evaluation with biopsy or referral to a subspecialist is warranted if ulcer healing stalls or the ulcer has an atypical appearance.1,5

• #18 Lower leg ulcer diagnosis and principles of treatment :: Cambridge Media Journals

  https://journals.cambridgemedia.com.au/jwm/volume-24-number-2/lower-leg-ulcer-diagnosis-and-principles-treatment

  Compression of the lower extremities veins and soft tissue leads to improved haemodynamics and thereby reduces the effects on the skin of venous hypertension and oedema. Non-adherence to compression may be the principal cause of slow healing or recurrence of VLU. […] The target for treating venous insufficiency is to relief symptoms, accelerate wound healing and prevent VLU occurrence and/or recurrence. In addition to venous intervention, compression is a key treatment and obligation in all oedema and venous insufficiency treatment. […] However, compression therapy is still one of the keystones in treatment of chronic ulcers, independently of the underlying aetiology. An ABI 0.8 may be considered as normal and allows commencement of full compression therapy (97). […] It is surprising how little focus has been attempted to the timing and accuracy of wound diagnostics as an outcome for wound healing. This document attempts to highlight the need for this. Even advanced treatments are predisposed to failure if the wound is not diagnosed correctly.

• #19 Venous leg ulcer | NHS inform

  https://www.nhsinform.scot/illnesses-and-conditions/skin-hair-and-nails/venous-leg-ulcer/

  You GP or nurse will carry out a test called the Doppler study. This helps to rule out peripheral arterial disease (a condition affecting the arteries). […] This involves measuring the blood pressure in the arteries at your ankles and comparing it to the pressure in your arms. If you have peripheral arterial disease, the blood pressure in your ankles will be lower than your arms. […] Its important to carry out this check as the main treatment for venous ulcers is compression bandages or stockings. This improves the vein circulation in your legs. Its not safe to apply compression if the ankle artery pressures are low. […] In some cases, your GP or nurse may decide to refer you to a specialist in conditions affecting the blood vessels (vascular specialist). […] The specialist will discuss your medical history and examine you. They may also need to arrange further investigations to plan your treatment.

• #20 Diagnostic and Treatment of Leg Ulcers | Actas Dermo-Sifiliográficas

  https://www.actasdermo.org/en-diagnostic-treatment-leg-ulcers-articulo-S1578219012000224

  Irrespective of the cause of the ulcer, a minimal assessment should be undertaken, and this should sometimes be complemented with a more in depth evaluation. […] The first step should be to collect information on underlying diseases and the use of any drugs that might affect wound healing or cause the ulcer. […] The first action should be palpation of the pedal pulses to assess a possible arterial component. […] The ankle-brachial index should be calculated for all patients using a handheld Doppler device. […] In all cases, we should carry out a routine laboratory workup to rule out hypoproteinemia and anemia, conditions which, along with hypovitaminosis C, A, and E, can be associated with delayed wound healing. […] All patients with a venous ulcer should undergo Doppler ultrasound as this technique provides valuable information on involvement of the superficial, perforator, and deep veins, and whether reflux, obstruction, or both are present.

• #21 Differential diagnosis of chronic leg ulcers – Servier – PhlebolymphologyServier – Phlebolymphology

  https://www.phlebolymphology.org/differential-diagnosis-of-chronic-leg-ulcers/

  Approximately 50% of venous ulcers are a consequence of CVI of the superficial venous system (intrafascial superficial veins with or without perforator insufficiency). […] The most difficult diagnostic and therapeutic problems are encountered in patients with leg ulcers in whom the major cause of the ulcer cannot be found, though a certain degree of venous insufficiency exists. […] The search for the cause of a leg ulcer should include a detailed medical history, physical examination, evaluation of arterial and venous blood flow, and suitable laboratory tests. […] Depending on the situation, microbiological tests, skin biopsy, radiologic imaging, and epicutaneous patch tests may be indicated. […] A correct sample must incorporate both the margin and base of the ulcer. […] The decision on when to take a leg ulcer biopsy is dependent on a number of criteria, but should be considered with: typical ulcers that do not respond to standard treatment or even worsen with treatment, atypical ulcers where the cause is not venous, arterial or neuropathic ulcers (vasculitis, systemic and other dermatologic diseases), ulcers highly suspicious for malignancy. […] The most useful approach to diagnose CVI is with Doppler and duplex sonography. Other procedures such as light reflection rheography (LRR), digital photoplethysmography (DPPG), and venous plethysmography (resting and dynamic) can be used as indicated.

• #22 Diagnosis and Treatment of Venous Ulcers | AAFP

  https://www.aafp.org/pubs/afp/issues/2010/0415/p989.html

  Venous ulcer, also known as stasis ulcer, is the most common etiology of lower extremity ulceration, affecting approximately 1 percent of the U.S. population. […] The diagnosis of venous ulcers is generally clinical; however, tests such as ankle-brachial index, color duplex ultrasonography, plethysmography, and venography may be helpful if the diagnosis is unclear. […] Determining etiology is a critical step in the management of venous ulcers. […] On physical examination, venous ulcers are generally irregular and shallow. Granulation tissue and fibrin are often present in the ulcer base. […] A clinical severity score based on the CEAP (clinical, etiology, anatomy, and pathophysiology) classification system can guide the assessment of chronic venous disorders. […] Poor prognostic factors for venous ulcers include large size and prolonged duration.

• #23 Evidence summary: Venous leg ulcers: diagnostic tools for venous disease :: Cambridge Media Journals

  https://journals.cambridgemedia.com.au/wpr/volume-26-number-4/evidence-summary-venous-leg-ulcers-diagnostic-tools-venous-disease

  The Clinical-Etiological-Anatomical-Pathophysiological (CEAP) classification scale is an international system for classifying symptoms of venous disease. The system has four sub-scales that are used to classify clinical presentation, primary cause of venous disease, anatomical location of the affected veins and type of disease. […] The Venous Severity Scoring system (VSS) is commonly used in conjunction with the CEAP scale to evaluate the severity of venous disease. The VSS comprises three reliable and valid tools, the Venous Clinical Severity Score (VCSS), the VSDS (see above) and the Venous Disability Score (VDS).

• #24 Venous ulcer – Wikipedia

  https://en.wikipedia.org/wiki/Venous_ulcer

  Venous ulcer is defined by the American Venous Forum as „a full-thickness defect of skin, most frequently in the ankle region, that fails to heal spontaneously and is sustained by chronic venous disease, based on venous duplex ultrasound testing.” […] The NICE guideline recommends that everyone with a venous leg ulcer, even if healed, should be referred to a vascular specialist for venous duplex ultrasound and assessment for endovenous surgery. […] A clinical severity score has been developed to assess chronic venous ulcers. It is based on the CEAP (clinical, etiology, anatomy, and pathophysiology) classification system developed by an expert panel. A high score gives a poor prognosis. […] A venous ulcer tends to occur on the medial side of the leg, typically around the medial malleolus in the 'gaiter area’ whereas arterial ulcer tends to occur on lateral side of the leg and over bony prominences.

• #25 Evidence summary: Venous leg ulcers: diagnostic tools for venous disease :: Cambridge Media Journals

  https://journals.cambridgemedia.com.au/wpr/volume-26-number-4/evidence-summary-venous-leg-ulcers-diagnostic-tools-venous-disease

  The Clinical-Etiological-Anatomical-Pathophysiological (CEAP) classification scale is an international system for classifying symptoms of venous disease. The system has four sub-scales that are used to classify clinical presentation, primary cause of venous disease, anatomical location of the affected veins and type of disease. […] The Venous Severity Scoring system (VSS) is commonly used in conjunction with the CEAP scale to evaluate the severity of venous disease. The VSS comprises three reliable and valid tools, the Venous Clinical Severity Score (VCSS), the VSDS (see above) and the Venous Disability Score (VDS).

• #26 Evidence summary: Venous leg ulcers: diagnostic tools for venous disease :: Cambridge Media Journals

  https://journals.cambridgemedia.com.au/wpr/volume-26-number-4/evidence-summary-venous-leg-ulcers-diagnostic-tools-venous-disease

  The Clinical-Etiological-Anatomical-Pathophysiological (CEAP) classification scale is an international system for classifying symptoms of venous disease. The system has four sub-scales that are used to classify clinical presentation, primary cause of venous disease, anatomical location of the affected veins and type of disease. […] The Venous Severity Scoring system (VSS) is commonly used in conjunction with the CEAP scale to evaluate the severity of venous disease. The VSS comprises three reliable and valid tools, the Venous Clinical Severity Score (VCSS), the VSDS (see above) and the Venous Disability Score (VDS).

• #27 Venous ulcer – Wikipedia

  https://en.wikipedia.org/wiki/Venous_ulcer

  Venous ulcer is defined by the American Venous Forum as „a full-thickness defect of skin, most frequently in the ankle region, that fails to heal spontaneously and is sustained by chronic venous disease, based on venous duplex ultrasound testing.” […] The NICE guideline recommends that everyone with a venous leg ulcer, even if healed, should be referred to a vascular specialist for venous duplex ultrasound and assessment for endovenous surgery. […] A clinical severity score has been developed to assess chronic venous ulcers. It is based on the CEAP (clinical, etiology, anatomy, and pathophysiology) classification system developed by an expert panel. A high score gives a poor prognosis. […] A venous ulcer tends to occur on the medial side of the leg, typically around the medial malleolus in the 'gaiter area’ whereas arterial ulcer tends to occur on lateral side of the leg and over bony prominences.

• #28 Diagnosis and Treatment of Venous Ulcers | AAFP

  https://www.aafp.org/pubs/afp/issues/2010/0415/p989.html

  Venous ulcer, also known as stasis ulcer, is the most common etiology of lower extremity ulceration, affecting approximately 1 percent of the U.S. population. […] The diagnosis of venous ulcers is generally clinical; however, tests such as ankle-brachial index, color duplex ultrasonography, plethysmography, and venography may be helpful if the diagnosis is unclear. […] Determining etiology is a critical step in the management of venous ulcers. […] On physical examination, venous ulcers are generally irregular and shallow. Granulation tissue and fibrin are often present in the ulcer base. […] A clinical severity score based on the CEAP (clinical, etiology, anatomy, and pathophysiology) classification system can guide the assessment of chronic venous disorders. […] Poor prognostic factors for venous ulcers include large size and prolonged duration.

• #29 Venous Ulcers: Diagnosis and Treatment – PubMed

  https://pubmed.ncbi.nlm.nih.gov/31478635/

  Venous ulcers are the most common type of chronic lower extremity ulcers, affecting 1% to 3% of the U.S. population. Venous hypertension as a result of venous reflux (incompetence) or obstruction is thought to be the primary underlying mechanism for venous ulcer formation. Risk factors for the development of venous ulcers include age 55 years or older, family history of chronic venous insufficiency, higher body mass index, history of pulmonary embolism or superficial/deep venous thrombosis, lower extremity skeletal or joint disease, higher number of pregnancies, parental history of ankle ulcers, physical inactivity, history of ulcers, severe lipodermatosclerosis, and venous reflux in deep veins. […] Poor prognostic signs for healing include ulcer duration longer than three months, initial ulcer length of 10 cm or more, presence of lower limb arterial disease, advanced age, and elevated body mass index. On physical examination, venous ulcers are generally irregular and shallow with well-defined borders and are often located over bony prominences. Signs of venous disease, such as varicose veins, edema, or venous dermatitis, may be present. Other associated findings include telangiectasias, corona phlebectatica, atrophie blanche, lipodermatosclerosis, and inverted champagne-bottle deformity of the lower leg. Chronic venous ulcers significantly impact quality of life. Severe complications include infection and malignant change. Current evidence supports treatment of venous ulcers with compression therapy, exercise, dressings, pentoxifylline, and tissue products. Referral to a wound subspecialist should be considered for ulcers that are large, of prolonged duration, or refractory to conservative measures. Early venous ablation and surgical intervention to correct superficial venous reflux can improve healing and decrease recurrence rates.

• #30 Diagnosis and Treatment of Venous Ulcers | AAFP

  https://www.aafp.org/pubs/afp/issues/2010/0415/p989.html

  Overall, acute ulcers (duration of three months or less) have a 71 to 80 percent chance of healing, whereas chronic ulcers have only a 22 percent chance of healing after six months of treatment. […] Given the poor healing rates associated with chronic ulcers, surgical evaluation and management should be considered in patients with venous ulcers that are refractory to conservative therapies.

• #31 Venous Ulcers: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0901/p298.html

  Venous ulcers are the most common type of chronic lower extremity ulcers, affecting 1% to 3% of the U.S. population. […] Venous ulcers are open skin lesions that occur in an area affected by venous hypertension.1 The prevalence of venous ulcers in the United States ranges from 1% to 3%.2,3 […] Initial noninvasive imaging with comprehensive venous duplex ultrasonography, arterial pulse examination, and measurement of ankle-brachial index is recommended for all patients with suspected venous ulcers.1 Color duplex ultrasonography is recommended to assess for deep and superficial venous reflux and obstruction.1,15 Because standard therapy for venous ulcers can be harmful in patients with ischemia, additional ultrasound evaluation to assess arterial blood flow is indicated when the ankle-brachial index is abnormal and in the presence of certain comorbid conditions such as diabetes mellitus, chronic kidney disease, or other conditions that lead to vascular calcification.1 Further evaluation with biopsy or referral to a subspecialist is warranted if ulcer healing stalls or the ulcer has an atypical appearance.1,5

• #32 Diagnosis and management of venous leg ulcers | The BMJ

  https://www.bmj.com/content/362/bmj.k3115.abstract

  Venous leg ulcers are the most severe manifestations of chronic venous disease caused by venous hypertension. […] Offer early referral to vascular specialists for ulcers that have not healed within two weeks of treatment or that recur. […] This clinical update, aimed at non-specialists, provides information on the diagnosis and management of venous leg ulcers, and offers multidisciplinary team support.

• #33 Venous ulcer – Wikipedia

  https://en.wikipedia.org/wiki/Venous_ulcer

  The main aim of the treatment is to create such an environment that allows skin to grow across an ulcer. In the majority of cases this requires finding and treating underlying venous reflux. […] The National Institute for Health and Care Excellence (NICE) recommends referral to a vascular service for anyone with a leg ulcer that has not healed within two weeks or anyone with a healed leg ulcer. […] It is not certain which dressings and topical agents are most effective for healing venous leg ulcers.

• #34 Diagnostic and Treatment of Leg Ulcers | Actas Dermo-Sifiliográficas

  https://www.actasdermo.org/en-diagnostic-treatment-leg-ulcers-articulo-S1578219012000224

  Ulcers are a frequent cause of dermatologic consultation, and most correspond to leg ulcers. […] The aim of this review is to update the reader’s knowledge of the treatment of ulcers in general and of leg ulcers in particular, with a detailed description of the new dressings available and of the new therapies for use in refractory cases. […] Differential diagnosis of leg ulcers involves consideration of a broad range of conditions. […] In routine clinical practice, when patients attend their family physician with a leg ulcer, they are usually referred directly to the nursing service without any prior assessment. […] Most leg ulcers are of vascular origin (85%), including venous ulcers (60%), arterial ulcers, and those that are a combination of both. […] The most common difficulty in daily practice is to distinguish between a leg ulcer of venous origin and arterial origin.

• #35 Differential diagnosis of chronic leg ulcers – Servier – PhlebolymphologyServier – Phlebolymphology

  https://www.phlebolymphology.org/differential-diagnosis-of-chronic-leg-ulcers/

  Chronic leg ulcers are nonhealing wounds on the distal aspects of the leg. Chronic venous insufficiency occurs when the venous system of the legs becomes inefficient and is a price we pay for our upright posture. The majority of chronic leg ulcers are caused by venous disease, but occasionally ulcers are associated with arterial problems or vessel inflammation (vasculitis). […] The correct diagnosis of the cause of leg ulceration is important as up to 20% are not of venous origin. […] Establishing the etiology of a leg ulcer is important as various treatment modalities are available, but the specific treatment will be dependent on the underlying ulcer cause. […] At least half of these ulcers have an underlying venous pathology, but the figure can be as high as 80%-90%, especially when ulcers localized to the foot are excluded.

• #36 Venous ulcer – Wikipedia

  https://en.wikipedia.org/wiki/Venous_ulcer

  Venous ulcer is defined by the American Venous Forum as „a full-thickness defect of skin, most frequently in the ankle region, that fails to heal spontaneously and is sustained by chronic venous disease, based on venous duplex ultrasound testing.” […] The NICE guideline recommends that everyone with a venous leg ulcer, even if healed, should be referred to a vascular specialist for venous duplex ultrasound and assessment for endovenous surgery. […] A clinical severity score has been developed to assess chronic venous ulcers. It is based on the CEAP (clinical, etiology, anatomy, and pathophysiology) classification system developed by an expert panel. A high score gives a poor prognosis. […] A venous ulcer tends to occur on the medial side of the leg, typically around the medial malleolus in the 'gaiter area’ whereas arterial ulcer tends to occur on lateral side of the leg and over bony prominences.

• #37 Perspective Chapter: Diagnosis and Treatment of Venous Leg Ulcer | IntechOpen

  https://www.intechopen.com/chapters/82402

  The application of objective tests aims to confirm the diagnosis, determine the etiology of the disease, locate the anatomical site of the venous disease (superficial, deep, and perforating venous system) and the severity of the disease, or identify coexisting peripheral arterial disease. […] In order to make a diagnosis, the following diagnostic procedures are recommended: ABPI and duplex venous mapping. […] The success and sensitivity of the color-flow duplex ultrasound depend on the researchers and the coefficient of variation of reflux measurements ranges from 30-45%. Studies have shown that duplex diagnostics has high sensitivity and specificity in the diagnosis of superficial and deep venous leg systems. […] Taking an ulcer biopsy is a quick, easy, and effective way to identify less common etiologies in ulcers that are unusual in appearance and where there is a reasonable suspicion of a malignant etiology. […] Successful treatment of VLUs requires a multidisciplinary team to make an adequate diagnosis, assess the condition of the vascular system and determine other factors that affect the healing of ulceration.

• #38 Lower leg ulcer diagnosis and principles of treatment :: Cambridge Media Journals

  https://journals.cambridgemedia.com.au/jwm/volume-24-number-2/lower-leg-ulcer-diagnosis-and-principles-treatment

  Compression of the lower extremities veins and soft tissue leads to improved haemodynamics and thereby reduces the effects on the skin of venous hypertension and oedema. Non-adherence to compression may be the principal cause of slow healing or recurrence of VLU. […] The target for treating venous insufficiency is to relief symptoms, accelerate wound healing and prevent VLU occurrence and/or recurrence. In addition to venous intervention, compression is a key treatment and obligation in all oedema and venous insufficiency treatment. […] However, compression therapy is still one of the keystones in treatment of chronic ulcers, independently of the underlying aetiology. An ABI 0.8 may be considered as normal and allows commencement of full compression therapy (97). […] It is surprising how little focus has been attempted to the timing and accuracy of wound diagnostics as an outcome for wound healing. This document attempts to highlight the need for this. Even advanced treatments are predisposed to failure if the wound is not diagnosed correctly.

• #39 Wound Care Today | May 2025

  https://www.woundcare-today.com/journals/issue/wound-care-today/article/differential-diagnosis-leg-ulcers-focus-atypical-ulcers

  The lack of an accurate diagnosis means that a leg ulcer will be challenging to treat effectively. […] A leg ulcer is a symptom of another condition and therefore it is important for nurses to ascertain the cause by implementing differential diagnostic procedures. […] The starting point is a thorough assessment of the patient, leg, and wound. […] A thorough assessment should allow the leg ulcer diagnosis to be noted and treatment started, or the patient referred on for further investigations and specialist treatment. […] Patients presenting with venous leg ulcers may give a history of previous varicose veins, deep vein thrombosis (DVT), leg surgery and trauma. […] Leg ulcers that are venous in origin are often relatively easy to diagnose with tell-tale signs of varicose veins, haemosiderin staining, lipodermatosclerosis, atrophie blanche, ankle flare, and eczema.

• #40 Wound Care Today | May 2025

  https://www.woundcare-today.com/journals/issue/wound-care-today/article/differential-diagnosis-leg-ulcers-focus-atypical-ulcers

  Treatment involves compression of the leg and a wound dressing appropriate for the ulcer. […] The clearest indication of the aetiology of a rheumatoid ulcer is a medical history of rheumatoid arthritis and foot deformities, although accompanying venous and arterial disease also need to be considered. […] Treatment of rheumatoid ulcers involves wound and exudate management and reduced compression. […] Drug-induced ulcers may exhibit the following characteristics: often located on the ankle and lower gaiter, painful, and sometimes surrounded by atrophie blanche. […] Therapeutic alternatives to the causative drug must be identified, or doses reduced if the ulcers are to heal. […] The treatment of any ulcer must begin with accurate diagnosis, which is often still lacking. […] When leg ulcers fail to respond to treatment or heal in an orderly manner despite optimal therapy, nurses should reconsider the diagnosis and, where necessary, refer on for specialist advice and management.

• #41 Perspective Chapter: Diagnosis and Treatment of Venous Leg Ulcer | IntechOpen

  https://www.intechopen.com/chapters/82402

  The application of objective tests aims to confirm the diagnosis, determine the etiology of the disease, locate the anatomical site of the venous disease (superficial, deep, and perforating venous system) and the severity of the disease, or identify coexisting peripheral arterial disease. […] In order to make a diagnosis, the following diagnostic procedures are recommended: ABPI and duplex venous mapping. […] The success and sensitivity of the color-flow duplex ultrasound depend on the researchers and the coefficient of variation of reflux measurements ranges from 30-45%. Studies have shown that duplex diagnostics has high sensitivity and specificity in the diagnosis of superficial and deep venous leg systems. […] Taking an ulcer biopsy is a quick, easy, and effective way to identify less common etiologies in ulcers that are unusual in appearance and where there is a reasonable suspicion of a malignant etiology. […] Successful treatment of VLUs requires a multidisciplinary team to make an adequate diagnosis, assess the condition of the vascular system and determine other factors that affect the healing of ulceration.

• #42 Venous Insufficiency & Ulcers | NewYork-Presbyterian

  https://www.nyp.org/vascular/venous-insufficiency-and-ulcers

  Doctors use an imaging test called a duplex ultrasound to determine if there is structural damage in the veins. […] Treatments for venous insufficiency are aimed at reducing swelling and improving the return of blood to the heart. […] Although venous insufficiency tends to get worse over time, early treatment can ease discomfort and prevent the condition from progressing. […] Our vascular specialists are board certified in vascular or endovascular medicine, cardiovascular disease, and interventional cardiology. […] They have expertise in diagnosing and treating abnormalities of the vascular/circulation system, including venous insufficiency, offering the highest level of specialized care and advanced therapies. […] Our vein specialists are experts in the full range of treatments, including the most serious forms of vein disease such as chronic venous insufficiency and ulcers.

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