Case report: Treatment of chronic venous ulceration

Chronic venous insufficiency (CVI) is a complex condition characterized by venous hypertension that can cause pain, swelling, edema, skin changes, or ulcerations of the leg, involving either the deep or superficial venous system. Venous ulcerations result from elevated ambulatory venous pressure or venous hypertension, leading to limb edema. The mainstay of treatment for this edema has been and continues to be compression therapy. Despite optimal medical therapy with external compression, venous ulcers of the lower extremities can be a chronic, long-term problem with recurrence rates as high as 70 %.

Herein, we describe a case of utilizing the best medical and surgical therapies including advanced wound care products to treat CVI and close chronic venous ulceration. A 66-year-old African American man with a history of heart failure and preserved ejection fraction, hypertension, hepatitis C, and CVI with recurrent bilateral venous ulcerations presented to the vascular surgery clinic for evaluation. Imaging was suggestive of normal arterial perfusion, and a venous reflux study, which was positive for diffuse venous reflux in the right leg along with an area of the greater saphenous vein in the calf with an arterial waveform concerning for arterial-venous fistula. He underwent sclerotherapy to the perforator vein, which was acting as an AVF feeding the ulceration. Conservative treatment with Unna boot and compression, the wound decreased in size and serial debridement with advanced wound care products were used to made to aid in the closure of this chronic wound.

Chronic venous insufficiency can lead to venous leg ulcerations, accounting for 80 % of all leg ulcerations. Treatment of the underlying CVI with surgical intervention and conservative compression therapy may not be enough to close a chronic venous ulcer alone. The SVS guidelines on managing venous ulcerations include comprehensive care, including compression therapy, local wound debridement, control of bioburden, wound moisture balance, and the possible use of advanced wound care products for chronic wounds.