Venous leg ulcers controllable with early intervention

Key Points

St. Louis - Venous leg ulcers are fairly common in the elderly population - 5 to 10 percent of seniors will experience them - but dermatologists can take steps to better diagnose, treat, manage and even prevent them, according to one expert.

"We have curative therapies for most leg ulcers, and we have therapies that can control the majority of remaining ulcers," says Jeffrey E. Petersen, M.D., a dermatologist in private practice at the St. Louis Dermatology & Surgery Center. "Today, most venous ulcers on the legs are either curable or controllable."

After the ultrasound evaluation, the next step is to determine where the problems are. They might be the saphenous vein, the greater saphenous vein, or the lesser saphenous vein.

Treatment options

Two new major areas of endovenous therapy are laser and radiofrequency, and the ultimate end result of the treatments is the same, according to Dr. Petersen. While he uses both modalities with equal regularity, Dr. Petersen says some patients are better candidates for one therapy over the other, and some elderly patients are not good candidates for either.

For the obese patient, the laser is more beneficial. The reasoning here is that one can allow the laser to heat up at the junction longer as needed.

For seniors who are concerned with discomfort during the procedure, the radiofrequency treatment tends to be better tolerated with respect to pain after surgery.

Whichever type of therapy is chosen, an important thing to remember is to make sure that all affected areas are treated properly.

"A lot of times physicians will treat only the bigger veins and the disease process will continue," Dr. Petersen says. "The ulcer will improve but then revert to the way it was. They key is to treat all of the offending veins or be sure to treat all of the areas that feed into the ulcer to get the area to heal."

Poor candidates

Some elderly patients are not good candidates for either type of treatment. These include patients who aren't mobile, who are in wheelchairs most of the day and whose legs are down and swollen. The other elderly population at higher risk for postprocedure complications includes the morbidly obese.

"The procedure presents the risk of deep vein thrombosis for seniors in these categories," Dr. Petersen says. "We aren't doing them a service by performing venous intervention on them."

Dr. Petersen cautions dermatologists that when they are fitting patients for compression stockings, to make sure the swelling is out of the leg before fitting the stocking.

"This way, we can fit the person with a compression stocking that will maintain the leg in a non-swollen state," he says. "This is probably the biggest mistake I see. Patients that wear a stocking with a swollen leg aren't making the leg smaller."