[Therapy of venous leg ulcers. New and established approaches]

Venous leg ulcers are the most severe complication of chronic venous insufficiency. Based on the pathogenesis and the clinical evidence, the first step in treating a venous leg ulcer should be the treatment of the venous insufficiency. According to the guidelines of the German Society of Phlebology, several methods are available: the surgical or interventional therapy of varicosities, the stenting of stenotic pelvic veins in a post-thrombotic syndrome, direct surgical intervention at the ulcer as excision, debridement or fasciotomy. In the case of an arthrogenic venous stasis syndrome, physical therapy can be helpful. Additionally wound dressings, medicinal therapy and reduction of pain are relevant.There is a good level of evidence only for sufficient compression therapy and elimination of varicosities by surgery or sclerotherapy.