Venous disease - Episode 98

Chronic venous insufficiency and venous ulcers require systematic assessment and management within general practice. Patients typically present with varicosities, hemosiderin deposition, and lipodermatosclerosis in the gaiter region. Diagnostic workup mandates a venous competency study to evaluate deep and superficial systems, alongside an ankle-brachial pressure index (ABPI) to determine the safety of compression therapy. Management centers on graduated compression—ideally class 3—and addressing bacterial colonization, particularly Pseudomonas, through silver dressings or acetic acid soaks. Vascular surgery referral is indicated for definitive treatment, such as endovenous ablation, provided the deep venous system remains patent. Clinicians must maintain a high index of suspicion for malignancy in chronic, non-healing wounds, necessitating biopsy to exclude conditions like Marjolaine’s ulcer. Dr. Samantha Peden, a vascular surgeon, emphasizes these clinical priorities to optimize patient outcomes and prevent long-term complications.