Available online 5 August 2023, 100896

This review provides a summary of current practice patterns in managing venous ulcers. The authors will describe the workup for venous ulcers, including differentiation of symptoms, physical examination, and imaging to guide the most effective treatment course for each patient. An overview of conservative management and minimally invasive treatment options for venous ulcers will be provided with a specific focus on peri-ulcer foam sclerotherapy to aid in preventing ulcer recurrence and promoting healing. We will give interventional troubleshooting techniques for challenging patient presentations.

Leg ulcers affect about 2% of the population in the United States, significantly impacting daily life, ranging from difficulty with mobility to pain and infection. Healthcare costs for treating and managing venous ulcers in the United States have been reported to be up to $15 billion per year1.

Leg ulcers can develop from multiple etiologies, including venous insufficiency (the most common cause), arterial insufficiency, and neuropathy. Approximately 70% of leg ulcers are primarily due to

Duplex ultrasound is the gold standard for diagnosing venous reflux and obstruction as the etiology for venous ulceration. Duplex ultrasound for evaluation of reflux is best performed with the patient in the standing position or reverse Trendelenburg if the patient cannot tolerate standing. Distal compression and release by manually squeezing the musculature or by using an automatic cuff inflator allow for evaluation of augmentation and the presence/duration of reflux. The Valsalva maneuver is

The majority of lower extremity ulcers are of venous origin. Workup includes a physical exam, history, grading of venous disease, and imaging. Although compression is the mainstay therapy for venous ulcers, there are improved outcomes with early endovenous intervention. The described techniques of perilesional sclerotherapy and perforator vein treatment have been shown to aid in healing venous ulcers, although much more research in this field is needed.

There are more references available in the full text version of this article.

© 2023 Published by Elsevier Inc.