Varicose veins and leg ulcers are both unsightly conditions that can cause pain, discomfort, and swelling. They often occur together, and evidence is emerging that treating varicose veins could help leg ulcers to heal. Leading vascular surgeon Mr Philip Coleridge Smith explains:
What are leg ulcers?
A venous leg ulcer is a sore that may develop on the leg, where high pressure in the veins has damaged the skin. It may be caused by a minor injury, but can also be associated with varicose veins in the leg.
Venous leg ulcers can take weeks or even months to heal, with regular dressings and often multiple visits to the doctor required to manage the problem. Standard treatment involves using compression garments, such as bandages or stockings to improve blood flow.
However, there is evidence that treating varicose veins can help venous leg ulcers to heal and lower the risk of recurrence.
How do you treat varicose veins?
Varicose veins can be treated surgically, or with modern endovenous methods. The latter are minimally invasive techniques, such as thermal ablation and foam sclerotherapy, which destroy the offending vein without the need for open surgery.
Can varicose vein treatments help leg ulcers?
The ESCHAR randomised clinical trial treated varicose veins surgically in patients with venous leg ulcers, and the results indicated that the treatment reduced the risk of ulcers returning. The more recent EVRA study examined the effect of minimally invasive endovenous ablation techniques on venous leg ulcer patient. The techniques used included laser ablation, radiofrequency ablation and foam sclerotherapy, which were used to destroy varicose veins in the patients early in their treatment. The patients who had this early intervention overall healed faster than those who didn’t.
The National Institute for Health and Care Excellence (NICE) clinical guidelines agree, advising that patients with leg ulcers by referred vascular surgeon as soon as possible, as an early intervention should make for a quicker recovery and reduce the chances of the ulcer returning.
Which varicose vein treatment is the best?
With the development of these newer techniques, vascular surgery has become more complex in recent years, and not all vascular surgeons will have fully mastered every technique. Although the newer endovenous techniques may lead to faster recoveries and less post-operative pain in general, the best outcomes are achieved when a surgeon performs a procedure that he has the most expertise in. With the range of treatments now available, it is important that the patient is fully informed of the options available and the risks and potential outcomes of each before going in for surgery.
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