Clinical Review

Chronic venous ulcer

BMJ 1997; 314 doi: (Published 05 April 1997) Cite this as: BMJ 1997;314:1019
  1. Niren Angle, resident in surgerya,
  2. John J Bergan, professor of surgerya
  1. a University of California, San Diego, San Diego, CA, USA
  1. Correspondence to: Professor Bergan North Coast Surgeons Medical group, 9850 Genesse Avenue, Suite 560, La Jolla, CA 92037, USA


    Venous ulceration is the most severe and debilitating outcome of chronic venous insufficiency in the leg. It is a common problem in clinical practice, with an estimated prevalence of 1-1.3%.1 2 Such ulceration is part of the complex of chronic venous insufficiency and is associated with distal vein hypertension. Chronic venous insufficiency and its accompanying venous hypertension have been termed the post-thrombotic syndrome, but it is now known that primary valvar incompetence, not just prior thrombosis, is an important cause of venous leg ulcer.3 Dysfunction of the superficial or perforating veins of the legs, alone or in combination, may be the only finding in leg ulceration.4 Nevertheless, a risk factor for venous ulceration remains a previous episode of deep vein thrombosis, which may or may not destroy venous valve function.5 It is clear, however, that a venous ulcer in the leg occurs mainly from reflux and not usually from persistence of the original obstructive process.6 7


    We relied largely on our own files to prepare this review. We accumulated these by weekly searches of Current Contents, which provides tables of contents of almost all medical publications published worldwide. Our files are arranged into categories, and the category of venous ulcer crosses many of these designations. Searches for evidence based information about venous disorders are often disappointing, but we used at least level 2 information whenever possible, tempered by our own experience. Diagnosis and treatment of venous disorders commands greater interest, and level 1 information is starting to appear, including treatment of venous thromboembolic disorders. This heralds better care of patients with venous problems. (Level 1 information means findings from large prospective randomised studies with definite conclusions that should be considered when managing any patient with the specified problem; level 2 information means findings from …

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