Surgical options for the treatment of venous ulcers

Venous ulcers are a difficult problem for both patient and physician. Healing of venous ulcers with compression therapy and elevation, although usually successful, often takes months. Some venous ulcers do not heal with conservative therapy, or if they do, can often recur. Proper evaluation of the lower extremity venous system, usually with noninvasive imaging, is essential in planning any surgical intervention. In the appropriate patient, a number of surgical options are available to achieve ulcer healing and/or to prevent recurrence. These options include ablation of superficial reflux, perforator interruption, deep venous reconstruction, and endovenous procedures.