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Varicose veins are a common problem, affecting up to 1 in 3 adults in their lifetime. They are usually a sign of an underlying venous insufficiency.
Thread veins can appear anywhere on the body but are mostly evidenced on the legs and face. They are more common than varicose veins, affecting up to 80% of adults.
Leg ulcers appear as broken skin in the lower leg or feet. We have been successfully treating venous leg ulcers for over 20 years.
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The below content has been medically reviewed and approved by Consultant Interventional Radiologist Dr. Mark Bratby(MBBS, MRCP, FRCR), Medical Director and Head of the Medical Advisory Committee at Veincentre.
Last reviewed 1st August 2024.
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Leg ulcers develop when an area of skin breaks down to reveal the tissue underneath. Venous ulcers are the most common type of leg ulcer, with over 60% of leg ulcers being venous, according to NHS statistics. It is estimated that they affect around 1 in 500 people in the UK. They usually occur just above the ankle and can also carry with them pain and other symptoms such as:
At Veincentre, we believe that living with ulcers is a thing of the past. We have over 20 years’ experience in treating venous leg ulcers via EVLA and foam sclerotherapy. All our treatments are walk-in, walk-out and require no surgery. We find that these methods lead to quicker healing and longer-lasting results than traditional approaches. In our experience, leg ulcers tend to remain healed following this treatment pathway.
Step 1 – Consultation
At Veincentre, your leg ulcer treatment journey starts with a simple ‘ABPI’ test to confirm whether the ulcer is venous (an issue with the veins), as we only treat venous ulcers at Veincentre. A colour duplex ultrasound scan is then performed, which confirms whether there is an underlying cause for the ulcers, i.e. varicose veins. The scan allows the consultant to look at the direction of blood flow inside the veins, as reverse blood flow indicates varicose veins. It is our experience that over 60% of ulcers are caused by venous issues however if we diagnose that the ulcer has another cause, our consultant will give you guidance on what to do next.
The results of your tests will be discussed there and then, along with a tailored treatment plan. The cost of this detailed appointment is just £350.
Step 2 – Primary Treatment
The most common treatment for your ulcer is with Endovenous Laser Ablation (EVLA) to treat the underlying cause, and/or sclerotherapy. By fixing the underlying cause of your venous ulcers, this will allow the ulcer to start healing and remove the need for ongoing treatment in the NHS.
Once your treatment is complete and the veins have closed, the leg ulcer will heal relatively quickly as the underlying cause which led to the ulcer has been fixed. The wound will close up, the redness will fade, and any eczema will begin to clear up. In a small number of cases you may find that some pigmentation or scarring left from the ulcer, depending on the severity of it.
Step 3 – Follow up
At your follow-up appointment, another scan is performed to check the underlying cause has been fixed. Often, the consultant will perform further sclerotherapy for any visible veins that are left to ensure you achieve your desired result.
Your follow-up appointment is recommended 6-8 weeks after the initial treatment.
ACCORDION ON WHERE BELOW?
We were delighted to see the results of the landmark UK-based EVRA randomised control trial published in the prestigious New England Journal of Medicine1 , which clearly supports our strategy. (EVRA is the acronym for the trial “Early Venous Reflux Ablation” .)
As the article itself states, this trial was the first to demonstrate that “early endovenous ablation of superficial venous reflux resulted in faster healing of venous leg ulcers and more time free from ulcers than deferred endovenous ablation”.
This followed an earlier study2 that had shown that traditional surgical correction of superficial venous reflux in addition to compression bandaging does not improve ulcer healing but reduces the recurrence of ulcers at four years and results in a greater proportion of ulcer-free time.
Although this earlier study had shown that surgical correction of venous insufficiency reduced recurrence, the fact that it also showed no improvement in ulcer healing held back the most effective treatment of venous leg ulcers by many years.
Venous leg ulcers appear as an open wound usually on the lower leg or ankle. The area around the wound will be red and there are likely to be skin changes such as venous eczema visible. If the ulcer is active, there may be discharge oozing from the wound, there may also be scabbed areas.
Following treatment for venous ulcers, the area will heal quite quickly. The wound will close up and the redness will fade, any eczema will begin to clear up.
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We would advise you to continue with your simple dressing and wearing the compression stocking provided by Veincentre for a week following EVLA and then to continue with dressings/bandaging provided from your GP surgery following this until the ulcer is fully healed.
With all medical treatments it’s important to weigh up the benefits versus the risks. With that in mind, we have provided you with a full outline of the known vein treatment risks.
References
1. A Randomized Trial of Early Endovenous Ablation in Venous Ulceration. May 31, 2018 N Engl J Med 2018; 378:2105-2114. DOI: 10.1056/NEJMoa1801214 (https://www.nejm.org/doi/full/10.1056/nejmoa1801214) 2. “Long term results of compression therapy alone versus compression plus surgery in chronic venous ulceration (ESCHAR): randomised controlled trial. BMJ. 2007 Jul 14;335(7610):83. doi: 10.1136/bmj.39216.542442.BE. Epub 2007 Jun 1.” (https://www.bmj.com/content/335/7610/83)
What causes an ulcer on the leg?
Venous leg ulcers are caused as a result of the skin breaking down, usually due to severe varicose veins. It can take many years to develop an ulcer and they are more common in the elderly due to more inactivity, however they can affect anyone at any age.
What causes leg ulcers in elderly?
Venous leg ulcers can develop in the elderly as a result of more inactivity and finding it more difficult to move around due to increasing age and conditions such as arthritis. This can worsen the blood circulation and cause skin changes, which can then turn into a venous ulcer.
What is the best dressing for leg ulcers?
Depending on the severity of your venous ulcer, you may be required to have it dressed regularly by a district nurse and they will use whichever dressings are the most suitable. If you suffer with leg ulcers and want more information on what dressings to use, please speak to your GP.
Could my leg ulcers be caused by varicose veins?
Most leg ulcers are caused by venous problems. The valve failure which causes ulcers is the same valve failure that causes varicose veins so most venous ulcers are also associated with varicose veins. Some patients however do get venous ulcers due to valve failure without any evidence of varicose veins.