Venous Stasis Overview


Vein Ulcer

Venous stasis refers to pooling of the blood in the veins of the lower leg particularly around the ankles. This occurs from chronic venous insufficiency, a medical condition when blood in veins leaks downwards in the wrong direction towards the foot creating venous hypertension. In severe cases of venous stasis, skin changes (darkening, dermatitis, fibrosis) and ulceration (an open wound) occurs on the lower legs.

Causes


Venous stasis ulcers are the most common cause of lower extremity ulcers, affecting 1% of the population. They are notoriously stubborn and typically take months to heal. Infection can set in while the wound is open. Even after healing, the wounds are prone to frequent recurrences. Coexisting risk factors such as immobility, DVT (blood clot), and coexisting medical conditions exacerbate the situation and delay healing. Venous stasis skin changes, while less severe than ulcers, are a clue that there is significant underlying venous disease. Varicose veins are commonly seen together with stasis changes and are another tip-off of a circulatory problem with the underlying veins.

Treatment


Venous stasis ulcers can be successfully treated with a wound care, compression therapy, and medication. It is imperative, however, to correct the underlying problem of leakage in the veins. This is accomplished after a thorough evaluation of the deep and superficial vein systems to understand the circulation and determine which veins are culprit. Vascular specialists can then decide how to best treat the problem veins. Treatments are typically performed via a catheter, laser or injection therapy, using minimally invasive techniques. Surgical intervention such as stripping and endoscopic perforator ligation (SEPS) can usually be avoided.

Our patient above presented with a nonhealing venous stasis wound of the medial ankle refractory to conservative treatment at the Wound Center. He was diagnosed with chronic venous insufficiency and underwent in-office vein treatment which corrected the underlying venous issue, reduced peri-wound pressure, and allowed for complete healing. The one year postop shows a closed wound and improvement in stasis discoloration as well.

For more information on venous stasis and treatments, contact one of our board-certified vascular specialists.

References:

  1. Management of venous leg ulcers: clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. O’Donnell TF et al. J Vasc Surg. 2014 Aug;60(2 Suppl):3S-59S

  2. Chronic venous insufficiency. Eberhardt RT, Raffetto JD. Circulation. 2014 Jul 22;130(4):333-46