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Venous Stasis Ulcer: Definition and Overview

A venous stasis ulcer, also called a venous ulcer or stasis ulcer, is an open sore that develops on the lower leg, most commonly around the ankle, due to problems with blood flow in the leg veins.  These ulcers are a result of chronic venous insufficiency, where the veins fail to efficiently return blood from the legs back to the heart, causing blood to pool (venous stasis) and increasing pressure in the veins.

Causes

Venous stasis ulcers occur primarily because of:

• Chronic venous insufficiency: Damaged or weakened vein valves allow blood to flow backward and pool in the lower legs, leading to increased venous pressure and tissue damage

• Varicose veins: Enlarged, twisted veins that often accompany valve dysfunction

• Venous hypertension: Persistently high pressure in the leg veins, especially when walking, which impairs healing and promotes ulcer formation.

• Other risk factors: Blood clots, obesity, prolonged standing, diabetes, kidney failure, and certain medications can further increase risk.

Symptoms and Appearance

Venous stasis ulcers typically present as:

• Open, shallow sores with a red or yellowish base and irregular borders.

• Most commonly located above the ankle or on the lower leg

• Surrounding skin may be discolored (red, brown, or purple), hardened, swollen, shiny, or warm.

• The ulcer may be painful, and there can be drainage, foul odor, or signs of infection if not properly managed

• Associated symptoms include leg swelling, heaviness, cramping, itching, and skin changes like stasis dermatitis.

Diagnosis

Diagnosis is usually clinical, based on the wound's appearance, patient history, and risk factors for venous disease. Additional tests may be performed to assess venous function and rule out other causes of ulcers.

Treatment

The main goals of treatment are to improve blood flow, promote wound healing, and prevent recurrence:

• Compression therapy: Wearing compression stockings or bandages to reduce swelling and support venous return is the cornerstone of treatment

• Wound care: Regular cleaning and dressing of the ulcer to prevent infection and promote healing

• Medications: Antibiotics if infection is present, pain management, and topical agents as needed.

• Lifestyle changes: Elevating the legs, exercising, weight management, and avoiding prolonged standing or sitting.

• Advanced therapies: In some cases, surgical procedures or hyperbaric oxygen therapy may be necessary for non-healing ulcers48.

Complications

Venous stasis ulcers can be slow to heal, often persisting for weeks, months, or even years if the underlying venous insufficiency is not addressed. They are prone to infection, which can further delay healing and increase the risk of more serious complications.

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