Venous ulceration: active approaches to treatment

Traditional treatment of venous ulceration has been conservative: elevation, wound care, compression, and patient education based on prevention. Conservative treatment will heal most ulcers over time: however, the data reflect a 29% to 59% recurrence rate with optimal care and follow-up. Recurrent ulceration results in significant cost and disability. It is none accepted that limbs with all the signs of severe chronic venous insufficiency (CVI) may have a normal deep venous system. Patients in whom this is the case can be treated surgically with good long-term results. In this article, the specific underlying causes of CVI are noted and diagnostic tests are reviewed. The CEAP (clinical signs, etiology, anatomy, and physiology) classification system is discussed in terms of systematically assessing CVI. Common surgical techniques are related to the underlying pathophysiology, and the nursing care of the patient undergoing surgical intervention is also discussed. The cause of the condition should be investigated, and surgical treatment, when appropriate, should be offered as an alternative to the active symptomatic patient with CVI.