Consensus paper on venous leg ulcer. The Alexander House Group

This is a condensed consensus report, summarizing the present status of various aspects of epidemiology, diagnosis, and treatment of venous ulcers. There are conflicting results regarding the prevalence of venous ulcers ranging from 0.18 to 1.3%, depending on the types of ulcers reported. With regard to macrovascular changes preceding venous leg ulceration, ambulatory venous hypertension is the common pathway, usually related to incompetent perforating veins and the deep venous system. Obstruction of the deep venous system seems to be less frequently related to venous ulcers. Microvascular changes have been recently studied in more detail; morphologic as well as functional changes are summarized and considered from the viewpoint of various hypotheses, including fibrin cuff, leukocyte adhesion, etc. Various investigational approaches are summarized and recommendations for the most cost-effective diagnostic tests are given. Finally, conservative medical as well as surgical treatment avenues are evaluated. Emphasis is given to the normalization of ambulatory venous pressure by sclerotherapy, ligation, or other surgical procedures, in addition to compression. The consensus report is concluded by detailed recommendations for future clinical trials.