• Venous Stasis Ulcer

    (Hypostatic ulcer; Stasis ulcer)

    Definition

    Venous stasis is a pooling of blood in the veins. A venous stasis ulcer is a wound on the surface of the skin caused by pooled blood. These ulcers occur most often on the legs.

    Causes

    Veins have a series of valves that help the blood move in the right direction. When these valves fail to work properly, blood can move backward and pool in the veins. The pooled blood pushes fluid and blood cells out of the veins and into nearby tissue. The leaked fluids irritate the tissue and cause inflammation. Over time, the inflammation can breakdown tissue and lead to ulcers.

    Risk Factors

    Venous stasis ulcers are more common in women than in men. It is also more common in older adults.
    Venous stasis increases your risk for this ulcer. Factors that may increase your risk of venous stasis include:
    Smoking is harmful to blood vessels and may play a role in venous stasis.
    Varicose Veins
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    Symptoms

    Venous stasis ulcers:
    • Have usually been there more than 4 weeks
    • May be painful and itchy
    • May have discolored, darkened, and scaly skin around the edges
    • May have foul-smelling discharge from the wound if an infection is present
    Venous stasis may also cause:
    • Swollen ankles, legs, and/or veins
    • Flaky, scaly, and itchy skin on the legs
    • Pain and/or heaviness in the legs

    Diagnosis

    You will be asked about your symptoms and medical history. A physical exam will be done. The diagnosis can often be done based on history and appearance alone.
    Ultrasound or other imaging test may be done to help identify underlying condition and to evaluate blood flow.

    Treatment

    Talk with your doctor about the best treatment plan for you. The ulcer will need some time to heal, usually 4 weeks or more. Special dressings are usually needed to help healing.
    Supportive care will help tissue heal as quickly as possible and decrease the risk of infection. Treatment may include:
    Decreasing venous stasis and moving excess fluid away from the area to further decrease irritation and help healing.
    • Compression stockings will usually be advised by your doctor
    • Elevate the affected limb above the heart when sitting
    • Perform exercises to help use muscle to pump fluid out of the area.
    Certain medication will help promote blood flow. They may be oral medications or be applied directly to the skin. Options may include:
    • Blood thinners
    • Statins
    • Aspirin
    Other topical medication may be used to improve the health of the skin to promote healing.
    Surgery may be needed to improve healing. Surgery may be done to:
    • Remove dead or infected tissue
    • Place healthy skin over the wound to help healing

    Prevention

    Venous stasis ulcers often recur. Prevention may include managing venous stasis or factors that worsen stasis by:
    • Ongoing use of compression stockings
    • Weight reduction in people with obesity
    • Treating any cause of the venous stasis

    RESOURCES

    Family Doctor—American Academy of Family Physicians https://www.familydoctor.org

    Society for Vascular Surgery https://vascular.org

    CANADIAN RESOURCES

    Canadian Vascular Access Association http://cvaa.info

    Health Canada http://www.canada.ca

    References

    Collins L, Seraj S. Diagnosis and treatment of venous ulcers. Am Fam Physician. 2010;81(8):989-996.

    Venous insufficiency and ulcers. New York-Presbyterian website. Available at: http://www.nyp.org/vascular/services/venous-insufficiency-and-ulcers. Accessed August 17, 2017.

    Venous leg ulcer. NHS Choices website. Available at: http://www.nhs.uk/Conditions/Leg-ulcer-venous/Pages/Introduction.aspx. Updated February 2, 2016. Accessed August 17, 2017.

    Venous leg ulcers. Patient website. Available at: https://patient.info/health/venous-leg-ulcers-leaflet. Updated August 1, 2016. Accessed August 17, 2017.

    Venous ulcer. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T115837/Venous-ulcer. Updated September 18, 2016. Accessed August 17, 2017.

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