Leg ulceration: the importance of treating the underlying pathophysiology

The last 20 years have seen considerable advances in the management of vascular diseases both in non-invasive imaging and minimally invasive surgical interventions. Colour duplex ultrasonography provides non-invasive and increasingly high-resolution anatomic and haemodynamic vascular information. This has been complimented by the development of minimally invasive interventional procedures such as subintimal angioplasty and endovenous treatments, all of which can be performed under local anaesthesia. These advances can now be utilized to improve both the assessment and management of patients with chronic leg ulceration where the aetiology is usually vascular and mostly primary venous insufficiency. Using non-invasive Doppler pressures and colour duplex imaging, the anatomic and haemodynamic pattern of the underlying vascular disease (and consequently the pathophysiology) can be precisely determined. This enables appropriate planning and targeting of effective management from an early stage in the history of any particular ulcer. This paper highlights the importance of achieving accurate diagnosis and instituting effective treatments that are appropriately targeted at the underlying pathophysiology, in patients with chronic leg ulceration, and describes how recent advances in technology and interventions have substantially increased the tools available to the vascular specialist. Thus allowing safe and effective management of what can otherwise become a prolonged or recurrent disease process.