Angiology: Open Access
Open Access

Management Strategies for Venous Ulcers in Chronic Venous Disease

Wijnand Bert^{* *}Correspondence: Wijnand Bert, Department of Vascular Surgery, Groene Hart Hospital, Gouda, Netherlands, Email:

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Description

Venous ulcers are a common and challenging complication of chronic venous disease (CVD), accounting for a significant proportion of lower limb ulcers worldwide. They arise due to sustained venous hypertension caused by valvular incompetence, venous obstruction, or calf muscle pump failure, leading to impaired blood return from the lower extremities. Over time, this results in tissue edema, inflammation, skin changes, and ultimately ulceration, most often around the medial ankle. Effective management of venous ulcers requires a comprehensive, multidisciplinary approach that addresses both the local wound and the underlying venous pathology to promote healing and prevent recurrence.

Compression therapy is the cornerstone of venous ulcer management and remains the most evidence-based intervention. By applying external pressure to the lower limb, compression reduces venous hypertension, improves venous return, decreases edema, and enhances microcirculatory flow. Compression can be delivered through multi-layer bandaging systems, short-stretch bandages, or graduated compression stockings, depending on the stage of healing and patient tolerance. Consistent and correct use of compression has been shown to significantly improve healing rates and reduce recurrence. However, patient education and adherence are critical, as improper use or discontinuation can compromise outcomes. Prior to initiating compression, arterial insufficiency must be excluded to avoid ischemic complications.

Local wound care is another essential component in managing venous ulcers. The primary goals of wound care are to maintain a moist healing environment, manage exudate, prevent infection, and protect the surrounding skin. Regular wound cleansing with non-irritating solutions helps remove debris and reduce bacterial burden. A wide range of dressings, such as hydrocolloids, foams, alginates, and antimicrobial dressings, may be selected based on wound characteristics, including exudate level and presence of infection. No single dressing type is universally superior; rather, individualized dressing selection based on clinical assessment is key to optimizing healing.

Infection control plays an important role, as venous ulcers are susceptible to bacterial colonization and infection due to chronic inflammation and skin breakdown. While most venous ulcers are colonized rather than infected, clinical signs such as increased pain, redness, warmth, purulent discharge, or delayed healing may indicate infection and warrant targeted antimicrobial therapy. Systemic antibiotics are reserved for cases with clear clinical infection, whereas topical antimicrobial agents may be used judiciously to reduce local bacterial load. Overuse of antibiotics should be avoided to prevent resistance and unnecessary side effects.

Addressing underlying venous insufficiency is crucial for long-term management and prevention of ulcer recurrence. Conservative measures such as leg elevation and regular ambulation help reduce venous pressure and improve calf muscle pump function. Patients are encouraged to elevate their legs above heart level when resting and to avoid prolonged standing or sitting. Structured exercise programs, particularly those focusing on ankle mobility and calf strengthening, can enhance venous return and contribute to ulcer healing. Lifestyle modifications, including weight management and smoking cessation, also support overall vascular health and improve treatment outcomes.

In selected patients, interventional and surgical treatments may be indicated to correct underlying venous abnormalities. Endovenous thermal ablation, sclerotherapy, or surgical ligation and stripping can be used to treat superficial venous reflux, which is a major contributor to venous hypertension. Evidence suggests that correcting venous reflux in addition to compression therapy can accelerate ulcer healing and significantly reduce recurrence rates. For patients with deep venous obstruction, specialized interventions may be considered in tertiary care settings. The choice of intervention depends on venous anatomy, ulcer characteristics, and overall patient health.

Patient education and long-term follow-up are vital elements of successful venous ulcer management. Chronic venous disease is a lifelong condition, and recurrence rates remain high without ongoing preventive care. Educating patients about the importance of continued compression use, skin care, early recognition of symptoms, and adherence to lifestyle recommendations empowers them to actively participate in their care. Regular follow-up allows healthcare providers to monitor healing progress, adjust treatment strategies, and reinforce preventive measures.

Conclusion

In conclusion, the management of venous ulcers in chronic venous disease requires an integrated approach that combines compression therapy, meticulous wound care, infection control, lifestyle modification, and treatment of underlying venous pathology. By addressing both the symptoms and the root causes of venous hypertension, clinicians can improve healing outcomes, enhance quality of life, and reduce the risk of ulcer recurrence. A patient-centered, multidisciplinary strategy remains the key to effective and sustainable management of this complex condition.