Abstract

Chronic venous disease (CVD) is prevalent in the aging population and leads to venous leg ulcers (VLUs). These wounds can last and recur for years, significantly impacting quality of life. A large body of literature exists on CVD and VLU diagnosis and treatment. Multiple algorithms, guidelines, and consensus documents have been published on this topic, highlighting the importance of this issue in clinical practice. Compression is still the mainstay of treatment for CVD and VLUs. Compression is needed long term, but it does not suffice by itself to prevent recurrences without interventional correction. Venous intervention should be offered early to prevent or slow disease progression and reduce recurrence.

• 1.   Margolis DJ, Bilker W, Santanna J, Baumgarten M. Venous leg ulcer: incidence and prevalence in the elderly. J Am AcadDermatol 2002;46:381– 386.
• 2.   Rice JB, Desai U, Cummings AK, Birnbaum HG, Skornicki M, Parsons N. Burden of venous leg ulcers in the United States. J Med Econ 2014;17: 347–356.
• 3.   Alavi A, Sibbald RG, Phillips TJ, et al. What’s new: management of venous leg ulcers: treating venous leg ulcers. J Am AcadDermatol 2016;74: 643–664; quiz 665–666.
• 4.   Bergan JJ, Schmid-Scho¨nbein GW, Coleridge Smith PD, Nicolaides AN, Boisseu MR, Eklof B. Mechanisms of disease—chronic venous disease. N Engl J Med 2006;355:488–498.
• 5.   Eklof B, Perrin M, Delis KT, et al. Updated terminology of chronic venous disorders: the Veinterm transatlantic interdisciplinary consensus document. J VascSurg 2009;49:498–501.
• 6.   Porter JM, Rutherford RB, Clagett GP, et al. Reporting standards in venous disease. J VascSurg 1988;8:172–181.
• 7.   Labropoulos N. How does chronic venous disease progress from the first symptoms to the advanced stages? A review. AdvTher 2019;36(Suppl 1): 13 19.
• 8.   Coleridge-Smith P, Labropoulos N, Partsch H, Myers K, Nicolaides A, Cavezzi A. Duplex ultrasound investigation of the veins in chronic venous disease of the lower limbs—UIP consensus document. Part I. Basic principles. EurJ VascEndovascSurg 2006;31:83–92.
• 9.   Porter JM, Moneta GL. Reporting standards in venous disease: an update. International Consensus Committee on Chronic Venous Disease. J VascSurg 1995;21:635–645.
• 10.   Eklof B, Rutherford RB, Bergan JJ, et al. Revision of the CEAP classification for chronic venous disorders: consensus statement. J VascSurg 2004;40:1248–1252.
• 11.   Lurie F, Passman M, Meisner M, et al. The 2020 update of the CEAP classification system and reporting standards. J VascSurg Venous LymphatDisord 2020;8:342–352.
• 12.   Rutherford RB, Padberg FT, Jr., Comerota AJ, Kistner RL, Meissner MH, Moneta GL. Venous severity scoring: an adjunct to venous outcome assessment. J VascSurg 2000;31:1307– 1312.
• 13.   Vasquez MA, Rabe E, McLafferty RB, et al. Revision of the Venous Clinical Severity Score: venous outcomes consensus statement: special communication of the American Venous Forum Ad Hoc Outcomes Working Group. J VascSurg 2010;52: 1387–1396.
• 14.   Eberhardt RT, Raffetto JD. Chronic venous insufficiency. Circulation 2014;130:333–34.
• 15.   Santler B, Goerge T. Chronic venous insufficiency—a review of pathophysiology, diagnosis, and treatment. J DtschDermatolGes 2017;15:538– 556.
• 16.   Raffetto JD. Pathophysiology of chronic venous disease and venous ulcers. SurgClin North Am 2018;98:337–347.
• 17.   Word R. Medical and surgical therapy for advanced chronic venous insufficiency. SurgClin North Am 2010;90:1195–1214.
• 18.   Barwell JR, Davies CE, Deacon J, et al. Comparison of surgery and compression with compression alone in chronic venous ulceration (ESCHAR study): randomised controlled trial. Lancet 2004; 363:1854–1859.
• 19.   Hedayati N, Carson JG, Chi YW, Link D. Management of mixed arterial venous lower extremity ulceration: a review. Vasc Med 2015;20:479– 486.
• 20.   Korstanje MJ. Venous stasis ulcers. Diagnostic and surgical considerations. DermatolSurg 1995; 21:635–640.
• 21.   O’Donnell TF, Jr., Balk EM. The need for an Intersociety Consensus Guideline for venous ulcer. J VascSurg 2011;54(6 Suppl):83S–90S.
• 22.   World Union of Wound Healing Societies (WUWHS). Principles of best practice: compression in venous leg ulcers. A consensus document. London: MEP Ltd., 2008:1–12.
• 23.   McGuckin M, Waterman R, Brooks J, et al. Validation of venous leg ulcer guidelines in the United States and United Kingdom. Am J Surg 2002;183: 132–137.
• 24.   Vowden P, Vowden K. Are we fully implementing guidelines and working within a multidisciplinary team when managing venous leg ulceration? Wounds UK 2013;9(Suppl 2):17–20.
• 25.   Harding K, Dowsett C, Fias L, et al. Simplifying venous leg ulcer management. Consensus recommendations. Wounds International, 2015. www.woundsinter national.com (last accessed October 14, 2020).
• 26.   Thomas DR. Managing venous stasis disease and ulcers. ClinGeriatr Med 2013;29:415–424.
• 27.   O’Donnell TF, Jr., Passman MA, Marston WA, et al. Management of venous leg ulcers: clinical practice guidelines of the Society for Vascular Surgery (R) and the American Venous Forum. J VascSurg 2014;60(2 Suppl):3S–59S.
• 28.   Ratliff CR, Yates S, McNichol L, Gray M. Compression for primary prevention, treatment, and prevention of recurrence of venous leg ulcers: an evidence-and consensus-based algorithm for care across the continuum. J Wound Ostomy Continence Nurs 2016;43:347–364.
• 29.   Widener JM. Venous leg ulcers: summary of new clinical practice guidelines published August 2014 in the Journal of Vascular Surgery. J VascNurs 2015;33:60–67.
• 30.   Harding K. Challenging passivity in venous leg ulcer care—the ABC model of management. Int Wound J 2016;13:1378–1384.
• 31.   Krishnan S, Nicholls SC. Chronic venous insufficiency: clinical assessment and patient selection. SeminInterventRadiol 2005;22:169–177.
• 32.   Wittens C, Davies AH, Baekgaard N, et al. Editor’s choice—management of chronic venous disease: clinical practice guidelines of the European Society for Vascular Surgery (ESVS). Eur J VascEndovascSurg 2015;49:678–737.
• 33.   Franks PJ, Barker J, Collier M, et al. Management of patients with venous leg ulcer: challenges and current best practice. J Wound Care 2016; 25(Suppl 6):1–67.
• 34.   Ito T, Kukino R, Takahara M, et al. The wound/ burn guidelines—5: guidelines for the management of lower leg ulcers/varicose veins. J Dermatol 2016;43:853–868.
• 35.   Tan MKH, Luo R, Onida S, Maccatrozzo S, Davies AH. Venous leg ulcer clinical practice guidelines: what is AGREEd? Eur J VascEndovascSurg 2019; 57:121–129.
• 36.   Alavi A, Sibbald RG, Phillips TJ, et al. What’s new: management of venous leg ulcers: approach to venous leg ulcers. J Am AcadDermatol 2016; 74:627–640; quiz 641–642.
• 37.   Gould LJ, Dosi G, Couch K, et al. Modalities to treat venous ulcers: compression, surgery, and bioengineered tissue. PlastReconstrSurg 2016; 138(3 Suppl):199S–208S.
• 38.   Fife CE, Carter MJ, Walker D. Why is it so hard to do the right thing in wound care? Wound Repair Regen 2010;18:154–158.
• 39.   Mooij MC, Huisman LC. Chronic leg ulcer: does a patient always get a correct diagnosis and adequate treatment? Phlebology 2016;31(1 Suppl): 68–73.
• 40.   Wound Ostomy and Continence Nurses Society Subcommittee. Ankle Brachial Index: quick reference guide for clinicians. J Wound Ostomy Continence Nurs 2012;39(2 Suppl):S21–S29.
• 41.   Sibbald RG, Goodman L, Woo KY, et al. Special considerations in wound bed preparation 2011: an update. Adv Skin Wound Care 2011;24:415–436.
• 42.   Wukich DK, Shen W, Raspovic KM, Suder NC, Baril DT, Avgerinos E. Noninvasive arterial testing in patients with diabetes: a guide for foot and ankle surgeons. Foot Ankle Int 2015;36:1391– 1399.
• 43.   American Diabetes Association. Standards of medical care in diabetes—2020. Diabetes Care 2020;43(Suppl 1):1–224.
• 44.   Olson JM, Raugi GJ, Nguyen VQ, Yu O, Reiber GE. Guideline concordant venous ulcer care predicts healing in a tertiary care Veterans Affairs Medical Center. Wound Repair Regen 2009;17: 666–670.
• 45.   Nelzen O. Fifty percent reduction in venous ulcer prevalence is achievable – Swedish experience. J VascSurg 2010;52(5 Suppl):39S–44S.
• 46.   Andriessen A, Apelqvist J, Mosti G, Partsch H, Gonska C, Abel M. Compression therapy for venous leg ulcers: risk factors for adverse events and complications, contraindications—a review of present guidelines. J EurAcadDermatolVenereol 2017;31:1562–1568.
• 47.   Youn YJ, Lee J. Chronic venous insufficiency and varicose veins of the lower extremities. Korean J Intern Med 2019;34:269–283.
• 48.   Wounds UK. Best practice statement: addressing complexities in the management of venous leg ulcers. Wounds UK, 2019. www.wounds-uk.com (last accessed October 14, 2020).
• 49.   Olszewski WL. The ‘‘third’’ circulation in human limbs—tissue fluid, lymph and lymphatics. Phlebologie 2012;41:297–303.
• 50.   Magnan VJ, Niezgoda JA. Wound Care Essentials, Practice Principles, 5th ed. Philadelphia, PA: Wolters Kluwer, 2020:435–466.
• 51.   Gasparis AP, Kim PS, Dean SM, Khilnani NM, Labropoulos N. Diagnostic approach to lower limb edema. Phlebology 2020;35:650–655.
• 52.   Bernatchez SF, Peterson L, Fife CE. Compression therapy: the key to unlocking VLU healing. Today’s Wound Clinic 2017;11:20–22.
• 53.   Partsch H, Mortimer P. Compression for leg wounds. Br J Dermatol 2015;173:359–369.
• 54.   Mosti G, Iabichella ML, Partsch H. Compression therapy in mixed ulcers increases venous output and arterial perfusion. J VascSurg 2012;55:122–128.
• 55.   Vowden P, Kerr A, Mosti G. Demystifying mild, moderate and high compression systems—when and how to introduce ‘‘lighter compression.’’ Wounds International, 2020. www.woundsinternati onal.com (last accessed November 10, 2020).
• 56.   5Anderson I. New research in compression therapy principles. Wounds UK 2013;9(Suppl 2):21–23.
• 57.   Schuren J, Mohr K. The efficacy of Laplaces’s equation in calculating bandage pressure in venous leg ulcers. Wounds UK 2008;4:38–47.
• 58.   Schuren J, Mohr K. Pascal’s law and the dynamics of compression therapy: a study on healthy volunteers. IntAngiol 2010;29:431–435.
• 59.   Flour M, Clark M, Partsch H, et al. Dogmas and controversies in compression therapy: report of an International Compression Club (ICC) meeting, Brussels, May 2011. Int Wound J 2013;10:516–526.
• 60.   Shepherd J. Progressive compression versus graduated compression for the management of venous insufficiency. Br J Community Nurs 2016; 21:S13–S18.
• 61.   Couzan S, Pouget JF, Le Hello C, Chapelle C, Laporte S, Mismetti P. High tolerance of progressive elastic compression in peripheral arterial disease. Vasa 2019;48:413–417.
• 62.   Mosti G. Compression and venous surgery for venous leg ulcers. ClinPlastSurg 2012;39:269–280.
• 63.   O’Meara S, Cullum N, Nelson EA, Dumville JC. Compression for venous leg ulcers (review). Cochrane Database Syst Rev 2012;11:1–196.
• 64.   Mauck KF, Asi N, Elraiyah TA, et al. Comparative systematic review and meta-analysis of compression modalities for the promotion of venous ulcer healing and reducing ulcer recurrence. J VascSurg 2014;60(2 Suppl):71S.e1 e2–90S.e1–e2.
• 65.   Rabe E, Partsch H, Morrison N, et al. Risks and contraindications of medical compression treatment—a critical reappraisal. An international consensus statement. Phlebology 2020;35:447–460.
• 66.   Raju S, Lurie F, O’Donnell TF, Jr. Compression use in the era of endovenous interventions and wound care centers. J VascSurg Venous LymphatDisord 2016;4:346–354.
• 67.   Jull AB, Arroll B, Parag V, Waters J. Pentoxifylline for treating venous leg ulcers. Cochrane Database Syst Rev 2012;12:CD001733.
• 68.   Mansilha A, Sousa J. Pathophysiological mechanisms of chronic venous disease and implications for venoactive drug therapy. Int J MolSci 2018; 19:1–21.
• 69.   Elankumar S, Chittoria RK, Kumaran MS, Sudhanva HK, Preethitha B, Friji MT, Mohapatra DP, Dineshkumar S. Role of Low Level Laser Therapy (LLLT) in the Management of Chronic Venous Ulcer: A Case Report. JSWCR 2016; 9(1):43 45.

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