Chronic Venous Insufficiency & Leg Ulcers

What is chronic venous insufficiency?

Chronic venous insufficiency (CVI) is most often the long-term consequence of leaking vein valves — the same disease process as varicose veins, further along the road. It can also follow a deep vein thrombosis (the post-thrombotic syndrome) or obstruction of the deep veins. Either way, blood pools in the lower legs under pressure, and over years that pressure damages the skin and tissues around the ankle.

How it progresses

CVI tends to advance through recognisable stages:

• Aching, heaviness and ankle swelling that builds during the day
• Skin changes — darkening (a rusty-brown discolouration), dryness, itching and eczema around the lower calf and ankle
• Lipodermatosclerosis — the skin and fat harden and the lower leg tightens like an inverted champagne bottle
• Venous ulcers — shallow, weeping, often painful wounds near the ankle that heal slowly or not at all

A venous ulcer is not a skin problem with a skin solution; it is a pressure problem. Dressings alone treat the surface while the cause persists.

How I assess it

Duplex ultrasound at the consultation maps exactly which veins are refluxing — superficial, deep or perforator veins — and whether an old deep vein thrombosis is contributing. I read the scan myself, and the treatment plan follows the map.

Treatment options

• Compression therapy — the foundation for symptom control and ulcer healing
• Endovenous ablation or medical adhesive closure of refluxing superficial veins — closing the leak reduces the pressure that prevents healing and cuts the risk of ulcer recurrence
• Foam sclerotherapy for tributaries and perforators
• Wound care for active ulcers, in parallel with treating the underlying veins

When to see a doctor promptly

Skin darkening or itching around the ankle, one leg swelling more than the other, or any wound near the ankle that has not begun healing within two weeks deserves early vascular assessment — ulcers prevented are far easier than ulcers healed.