Venous stasis ulcers are caused by a problem in veins. Valves in the veins normally move blood in the right direction. When the valves fail, blood flows backward and pools in the veins. This pushes blood cells and fluid into nearby tissue. The leaked fluids irritate the tissue. Over time, inflammation causes ulcers to form.

Risk Factors

Venous stasis ulcers are more common in women and people over 65 years old. Other things that raise the risk are:

Vein problems, such as:
- Deep vein thrombosis—blood clot in a deep vein
- Varicose veins and surgery to remove them
- Phlebitis —inflammation of blood vessels
Injury to the leg or veins
Family history of long term vein disease
Heart failure
Obesity
Inactivity
Injection drug use

Smoking is harmful to blood vessels. It may also play a role in venous stasis.

Varicose Veins

Symptoms

Venous stasis ulcers are often on the legs or ankles. Symptoms are sores that may:

Be present for 4 or more weeks
Cause mild to severe pain
Be discolored, darkened, and scaly around the edges
Have a bad smelling discharge—if infected

Diagnosis

The doctor will ask about symptoms and past health. A physical exam will be done. This is often enough to make the diagnosis.

The doctor may check blood flow around the ankle. This is done with a blood pressure cuff.

Treatment

The goal is to heal the ulcer. Treatment depends on how severe the condition is.

Excess fluid can cause irritation and further damage. The excess fluid will need to be moved away from the area. Options are:

Compression stockings
Raising the affected limb above the heart when sitting
Exercises—to help pump fluid out of the area

Medicine may also help to improve blood flow. The medicine may be taken by mouth or applied to the skin. Options may be:

Statins
Aspirin
Pentoxifylline

Other medicine may be applied to the skin—to help healing, ease pain, and prevent infection.

Surgery may be needed for larger wounds to:

Remove dead or infected tissue
Place healthy skin over the wound to help healing

Prevention

Venous stasis ulcers often happen again. Managing venous stasis will help prevent future ulcers. Things that may help are:

Use of compression stockings
Weight control—for those with obesity
Treating any cause of the venous stasis

RESOURCES:

Family Doctor—American Academy of Family Physicians
https://www.familydoctor.org

Society for Vascular Surgery
https://vascular.org

CANADIAN RESOURCES:

Canadian Vascular Access Association
http://cvaa.info

Health Canada
http://www.canada.ca

References:

Bonkemeyer Millan S, Gan R, et al. Venous ulcers: diagnosis and treatment. Am Fam Physician. 2019;100(5):298-305.

Venous insufficiency and ulcers. New York-Presbyterian website. Available at: https://www.nyp.org/vascular/venous-insufficiency-and-ulcers. Accessed August 5, 2021.

Venous leg ulcer. NHS Choices website. Available at: https://www.nhs.uk/conditions/leg-ulcer/ Accessed August 5, 2021.

Venous ulcer. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/venous-ulcer. Accessed August 5, 2021.

Last reviewed July 2021 by EBSCO Medical Review Board Dan Ostrovsky, MD
Last Updated: 8/5/2021

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