Vascular Medicine & Dermatology & Vascular Surgery & Family Medicine
Chronic venous insufficiency
Chronic venous insufficiency (CVI) is a group of clinical manifestations resulting from lasting impairment of venous return from the lower limbs, mainly due to pathological venous reflux, venous obstruction or both combined. It affects 25-35 % of adult women and 10-20 % of men in Western countries, representing a major public health problem due to its impact on quality of life and its medico-social cost. CVI is classified using the internationally adopted CEAP (Clinical - Etiological - Anatomical - Pathophysiological) system, which describes the clinical extent from C0 (absence of signs) to C6 (active venous ulcer). The central pathogenesis is based on venous valve failure - either primary (idiopathic myxomatous degeneration) or secondary (post-thrombotic) - leading to venous blood reflux during muscle contraction, ambulatory venous hypertension and chronic microvascular congestion. Chronic venous hypertension leads to leukocyte activation, release of inflammatory mediators (TNF-α + IL-1 + MMP), pericapillary extravasation of fibrin and red blood cells, lipodermatosclerosis and, in the final stage, venous leg ulcer. Management is graded: medical venous compression (compression stockings or tapes) as 1st line treatment for all symptomatic stages, venotonics, sclerotherapy and thermal endovenous techniques (laser + radiofrequency) for varicose veins, specialized wound care for ulcers, and surgery in selected cases.
CEAP classification, pathophysiology and clinical evaluation
- CEAP classification and pathophysiology of chronic venous hypertension : CEAP classification (revised 2020 - Lurie 2020 - Journal of Vascular Surgery): dimension C (Clinical - clinical manifestations): C0: no visible or palpable sign of CVI → C1: telangiectasias (subdermal venules 3 mm in standing position) → C2r: recurrent varicose veins → C3: edema (reducible on elevation) → C4: trophic skin changes: C4a: pigmentation (hemosiderin deposition) + stasis dermatitis (varicose eczema) → C4b: lipodermatosclerosis (subdermal skin fibrosis) + white atrophy (cicatricial pearly white patches - white atrophy plaques) → C4c: corona phlebectatica (fan-shaped dilatation of ankle veins) → C5: healed venous ulcer → C6: active venous ulcer → E dimension (etiological): Ep (primary - idiopathic) + Es (secondary - post-thrombotic + post-traumatic) + Ec (congenital - malformations) + En (unknown etiology) → A dimension (anatomical): As (superficial) + Ap (perforating) + Ad (deep) + An (unidentified) → P dimension (pathophysiological): Pr (reflux) + Po (obstruction) + Pro (reflux + obstruction) + Pn (unknown); pathophysiology of venous hypertension and venous reflux: normal venous circulation: venous return provided by calf muscle pump (contraction → compression of deep veins → progression to heart) + anti-reflux valves in superficial + perforating + deep veins → standing at rest: tibial venous pressure ≈ 80-100 mmHg (hydrostatic column) → walking: pressure drops to 30 mmHg) → microvascular consequences of venous hypertension: dilatation and tortuosity of capillaries → increased vascular permeability → extravasation of proteins + red blood cells + fibrin → pericapillary deposits of fibrin (fibrous mantle) → reduced oxygen exchange → activation of leukocytes (polynuclear + macrophages) → release of inflammatory mediators (TNF-α + IL-1β + MMP-1 + MMP-9) → destruction of connective tissue → lipodermatosclerosis → ulceration → Coleridge Smith 1988 - Lancet : leukocytes trapped in congested venous capillaries → activation → chronic inflammation → cycle of tissue destruction → primary vs. secondary mechanisms: primary reflux (85-90 %): myxomatous degeneration of valves → alteration of elastic fibers of the venous wall → distension → valvular incontinence → autosomal dominant inheritance (concordance 75-90 % if both parents affected) → secondary reflux (10-15 %): post-thrombotic syndrome (PTS): deep vein thrombosis → destruction or fusion of valves → obstruction + reflux → PTS incidence: 20-50 % after proximal DVT → lipodermatosclerosis + hyperpigmentation → recurrent venous ulcers → Prandoni 2009 - Haematologica: incidence of PTS + risk factors.
- Clinical evaluation and paraclinical examinations : structured questioning: symptoms : heaviness + heaviness + tension in the legs (aggravated at the end of the day + by prolonged standing + in the heat) + peri- varicose pruritus + burning + nocturnal cramps + pain + impatience + improvement → elevation of the lower limbs + walking (activation of the muscular pump).varicose pruritus + burning + nocturnal cramps + pain + impatience → improvement with elevation of lower limbs + walking (activation of muscle pump) + wearing venous compression → aggravation with prolonged static standing + during pregnancy + heat + summer → CIVIQ questionnaire (Chronic Venous Insufficiency Questionnaire) + VAS (Visual Analogue Scale) → history : DVT + VTE + pregnancies + pelvic surgery + obesity + sedentary lifestyle + static standing occupation + estroprogestative contraception + family history of CVI → standing physical examination (physiological position): inspection: type and distribution of varicose veins (internal safene - great saphenous vein VGS + external safene - small saphenous vein VPS + perforators) + location and character of skin changes + venous ulcer (flat edges + irregular contours + fibrinous or budding background + mild pain + internal peri-malleolar location ++) + edema (bilateral or unilateral - if unilateral → DVT to be excluded) + palpation: Schwartz sign (percussion of varicose veins → distally palpable shock wave) + Trendelenburg sign (tourniquet + lifting of limb → emptying varicose veins → then release → if rapid filling → saphenous reflux) → venous echo-Doppler (venous duplex): reference examination → anatomical and functional assessment → mapping of reflux + obstructions → duration of reflux: >0.5 s in superficial veins (>1 s in deep veins) → confirms CVI → assesses perforator competence + essential before any therapeutic procedure (sclerotherapy + thermal endovenous + surgery) → venous plethysmography + phlebography (reserved for complex cases or before reconstructive surgery) + air plethysmography: measures reflux pressure + muscle pump function
Treatment of chronic venous insufficiency
| Treatment / shape | Data, methods and results | Key studies and recommendations |
|---|---|---|
| Medical venous compression - first-line treatment Compression stockings - bands - compression classes - mmHg - indications - contraindications - adhesion - compliance - IOAP - edema |
Medical venous compression (MVC) - mainstay of treatment for any symptomatic CVI: mechanism: external compression → reduction in diameter of distended veins → increase in venous flow velocity → improvement in relative valvular competence → reduction in ambulatory venous hypertension → reduction in capillary congestion + edema → skin protection against ulceration; classification of compression levels (European standards EN 13944): class I: 15-21 mmHg → mild varicose veins + symptomatic telangiectasias + mild edema + prevention → class II: 23-32 mmHg → moderate to severe varicose veins + chronic edema + IVC C2-C4 + venous insufficiency during pregnancy → class III: 34-46 mmHg → severe CVI (C4-C6) + post-thrombotic syndrome + venous ulcers → class IV: >49 mmHg → lymphedema + severe CVI with lymphedema → Canadian standards: similar standards → stockings available reimbursed by some health insurance plans in Quebec depending on indications → forms available: shank stockings + knee-highs + tights → put on in the morning before getting up for optimal effect → compression bands (multi-layer bandages - Profore): for acute edema + venous ulcers → daily application by trained nurse or patient + pneumatic intermittent compression devices: for refractory ulcers + lymphedema; clinical efficacy of CVM: Raju 2007 - Journal of Vascular Surgery: venous compression in CVI → edema reduction + symptom improvement → level of evidence A → Palfreyman 2007 - Cochrane: venous compression + venous ulcers → increased healing rates × 2-3 vs no compression → Partsch 2003 - Phlebology: decreasing compression gradient from foot to thigh → optimal for venous return → Mosti 2013 - Phlebology: high-pressure compression bands → more effective reduction of edema + symptoms vs low-pressure bands → problem of adherence (compliance): main obstacle → 30-50 % of patients abandon MVC → reasons: heat + difficulty putting on (elderly subject) + aesthetics + cost → means of improving adherence: devices to aid donning (low threaders) + explanation of expected benefits + choice of models + ABI (ankle-brachial index) before prescription : SPI (systolic pressure index) = ankle pressure / arm pressure → if SPI <0.8 → AOMI (obliterative arteriopathy of the lower limbs) → strong compression CONTRAINDICATED → risk of ischemic necrosis → light compression (class I - 15-20 mmHg) cautious if SPI 0.6-0.8 after vascular advice → contraindications for strong CVM (class III-IV): severe OAMI (GPI <0.5) + untreated deep phlebitis + severe decompensated heart failure + infectious dermatosis | Raju 2007 - Journal of Vascular Surgery: CVM in CVI → level of evidence A + Palfreyman 2007 - Cochrane: compression + venous ulcers → healing × 2-3 vs without → Partsch 2003 - Phlebology: optimal decreasing gradient + Mosti 2013 - Phlebology: high pressure → superior edema reduction → O'Meara 2012 - Cochrane: venous compression in leg ulcers → comprehensive review → NICE 2013 NG149: compression = 1st-line treatment IVC + venous ulcers + Australian and New Zealand Society for Vascular Surgery (ANZSVS) 2021 + European Venous Forum (EVF) 2022 + Société française de phrébologie (SFP): CVM = 1st line in all symptomatic forms of CVI → Christopoulos 2019 - JVSV: recommendations for compression in CVI + NICE 2023 NG168: varicose veins + CVI → CVM before any intervention + SOGV/SVS 2023: North American recommendations |
| Varicose vein treatments - sclerotherapy, thermal endovenous techniques and surgery Sclerotherapy - polidocanol - tetradecyl sulfate - foam - EVLA endovenous laser - RFA radiofrequency - stripping - crossectomy - thermal ablation - results - recurrence |
Sclerotherapy - reference treatment for telangiectasias and small varicose veins: mechanism: injection of a sclerosing agent → endothelial lesion → inflammation + fibrosis → occlusion of the venous lumen → resorption → sclerosing agents : polidocanol (Aethoxysklerol - 0.5 % + 1 % + 2 % + 3 %) → less painful + better tolerance profile + sodium tetradecylsulfate (Fibrovein - 0.2 % + 0.5 % + 1 % + 3 %) → chrome glycerine (telangiectasias only) → techniques: liquid sclerotherapy: for telangiectasias + small reticular veins → foam sclerotherapy: mixture of sclerosing agent with air or CO₂ (Tessari technique) → agent/air ratio = 1:4 → foam more effective because prolonged contact with the wall → treatment of venous trunks + medium-caliber varicose veins → echo-Doppler guidance if large or deep varicose veins + Thivard 2002 - Journal of Dermatologic Surgery: foam sclerotherapy → superior efficacy to liquid sclerotherapy for venous trunks + Barrett 2010 - Cochrane : foam sclerotherapy vs liquid sclerotherapy → superior results for obliteration of varicose veins → sclerotherapy results: telangiectasias: disappearance rate at 1 year: 70-85 % → frequent recurrences (regular follow-up required) → medium-caliber varicose veins: obliteration at 1 year: 60-75 % + adverse effects: brown pigmentation (hemosiderin) → 10-30 % → regression in 6-18 months + local superficial thrombophlebitis → skin necrosis (rare if correct technique) + visual migraine (foam + patent foramen ovale) → low risk of VTE if doses respected; thermal endovenous techniques - current standard for large varicose trunks (VGS + VPS): endovenous laser (EVLA - Endovenous Laser Ablation): introduction of a laser fiber (wavelength 810-1,470 nm depending on device) under echo guidance into the venous trunk → thermal energy → wall injury → obliteration → endovenous radiofrequency (RFA - Radiofrequency Ablation - ClosureFAST): 120°C heating catheter → 7 cm segments → obliteration → Rasmussen 2011 - Journal of Vascular Surgery (RCT): EVLA vs RFA vs stripping + sclerotherapy → comparable results at 5 years + RFA and EVLA = less painful + faster recovery + Jia 2007 - Cochrane: EVLA + RFA vs stripping → equivalent efficacy + less morbidity → thermal ablation = 1st-line treatment of main venous trunks according to SVS/AVF 2012 guidelines + EVF + NICE 2023 NG168 → EVLA results: trunk obliteration at 5 years: 85-95 % → RFA results: obliteration at 5 years: 80-90 % → recurrences at 5 years: 15-30 % → related to neovascularization + persistent incompetent perforators → non-thermal non-sclerosing techniques: venous glue (cyanoacrylate - VenaSeal): echo-guided injection → no tumescent anesthesia → comparable results at 2 years → MOCA (Mechanochemical Ablation - ClariVein): rotating wire + sclerosant injection → no thermal anesthesia → promising results + few long-term data; varicose vein surgery - crossectomy + stripping: crossectomy (flush ligation): ligation of the saphenofemoral junction (SFJ) or saphenopopliteal junction (SPJ) + stripping (surgical removal of the saphenous trunk): Babcock route → 5-year results: continence in 75-85 % → 10-year recurrence: 25-40 % → very low operative mortality (<0.1 1 %) → but: morbidity (hematoma + pain + paresthesias due to saphenous nerve damage) + less used since the development of endovenous techniques → still indicated if: very tortuous veins + caliber unsuitable for endovenous techniques + complex recurrences + ambulatory (ambulatory phlebectomies - micro-incisions): removal of secondary varicose veins + varicose branches → under local anesthesia → long-lasting results + well tolerated | Rasmussen 2011 - Journal of Vascular Surgery (RCT): EVLA vs RFA vs stripping → comparable results at 5 years → RFA + EVLA less painful + faster recovery + Jia 2007 - Cochrane: EVLA + RFA vs stripping → equivalent + less morbidity + Hamann 2019 - JVSVS: VenaSeal (venous glue) vs RFA → comparable results at 2 years + Barrett 2010 - Cochrane: foam vs liquid sclerotherapy → superior obliteration + Thivard 2002 - JDS: foam sclerotherapy → results + SVS/AVF 2012 (Gloviczki - Journal of Vascular Surgery): SVS guidelines for varicose veins → thermal ablation = 1st line for venous trunks + NICE 2023 NG168: varicose veins → EVLA or RFA preferred to stripping → foam sclerotherapy if EVLA/RFA impossible + EVF 2022: position paper treatment IVC + varicose veins + Christopoulos 2019 + Canadian SOGV 2023 + INESSS: management of varicose veins in Quebec → reimbursement indications |
| Venous leg ulcers - specialized management C5-C6 ulcer - wound care - strong compression - detersion - hydrocolloid - absorbent film - Profore - culture - superinfection - penoxifylline - etiological treatment - skin grafting |
Venous leg ulcer (VLU) - background and presentation: VLU accounts for 70-80 % of all leg ulcers → typical location: medial peri-malleolar region (lower leg) → irregular but flat margins → fibrinous or budding background + peri-ulcer hyperpigmentation + lipodermatosclerosis → little or moderate pain (unlike arterial ulcer) → variable size (a few cm² to giant ulcers) → long duration (months to years) → frequent recurrence (30-70 % at 5 years without treatment of the cause) → systematic preliminary workup: venous echo-Doppler + SPI (systolic pressure index) to exclude arterial component + CBC + CRP + albumin + glycemia (T2DM) + biopsy if tumor or atypical pathology suspected (if resistant to treatment >3 months) → basic principles of UVJ management: detersion: removal of necrotic + fibrinous tissue + bacterial biofilm → methods: autolytic detersion (moist dressings + hydrocolloids) + mechanical (washcloths + curette) + enzymatic (collagenase) + biological (maggots) + TIMERS technique (Tissue + Infection/Inflammation + Moisture + Edge + Repair/Regeneration + Social factors) + type of dressings according to the nature of the wound base: fibrinous + exudative background: alginates + hydrocolloids + absorbent polyurethane → clean budding background: non-adherent interface + light hydrocolloid + infected background: ionic silver + cadexomeric iodine (Iodosorb) + do not use iodine dressings routinely without active infection + atonic background: growth factors (PDGF) + hydrocolloid + frequency of care: 1-3 times/week depending on exudate + measurement of wound area at each consultation (documentation of progress); compression - absolute mainstay of UVJ treatment: multilayer compression bands (Profore - 4-layer system - pressure ≥40 mmHg at the ankle) → Palfreyman 2007 - Cochrane: multi-layer vs. single-layer compression → superior healing rate (multi-layer) + O'Meara 2012 - Cochrane: CVM + ulcers → significantly improved healing vs. without compression → level of evidence A + active stage: daily strips → at advanced healing stage: class III compression stockings → adjuvant pharmacological treatment of UVJ: pentoxifylline (Trental) 400 mg × 3/d : hemorheological agent → improved erythrocyte deformability + reduced blood viscosity + PMN inhibition → Jull 2012 - Cochrane: pentoxifylline + UVJ → increased healing rate + recommended if insufficient compression or recalcitrant ulcer → micronized purified flavonoid fraction (MPFF - Daflon) + venotonics: limited data in UVJ → systemic antibiotics: only if signs of clinical infection (peri-ulcer cellulitis + purulence + fever) → no systematic antibiotic therapy on a simple positive culture (colonizing biofilm = present in all chronic UVJ) → culture only if cellulitis or signs of clinical infection → skin grafting (fillet autograft + biological equivalent dermis + allodermis): indicated if very extensive + or resistant ulcer after >6-12 weeks of well-conducted optimal treatment → Lassus 2008 - Vascular + review: UVJ skin graft → improved healing in selected ulcers + etiological treatment of varicose veins: sclerotherapy + or EVLA + or RFA of incompetent trunks → after healing or sometimes in parallel → Gohel 2018 - NEJM (EVRA trial RCT) : early removal of incompetent trunks (during ulcer treatment) → faster healing (56 vs 82 days) + reduced risk of recurrence at 3 years → early etiological treatment = current standard + long-term follow-up: wear class II-III compression stockings for life after healing → to prevent recurrence | Palfreyman 2007 - Cochrane: multilayer vs monolayer compression → superior healing rate + O'Meara 2012 - Cochrane: CVM + ulcers → improved healing vs no compression → A level + Jull 2012 - Cochrane: pentoxifylline → increased healing rate in UVJ → recommended as adjuvant + Gohel 2018 - NEJM (EVRA trial RCT n=450): early removal of incompetent varicose veins during ulcer treatment → faster healing (56 vs 82 days - p<0.0001) + reduced recurrences → revolution in UVJ management → NICE 2023 NG168: early etiological treatment (EVLA/RFA/sclerotherapy) during ulcer treatment → recommended + SVS/AVF 2012 + EVF 2022: compression + etiological treatment = UVJ reference standard + Coleridge Smith 1988 - Lancet: pathophysiology of UVJ + trapped leukocytes + inflammation → Prandoni 2009 - Haematologica: post-thrombotic syndrome + UVJ → frequency + risk factors |
| Veinotonics, post-thrombotic syndrome and dietary hygiene measures MPFF Daflon - diosmin hesperidin - hydroxyethylrutosides - post-thrombotic syndrome SPT - DVT anticoagulation - postural measures - physical exercise - weight loss - pregnancy |
Veinotonics (phlebotonics): micronized purified flavonoid fraction (MPFF - Daflon 500 mg or 1,000 mg): micronized diosmin-hesperidin fraction → mechanism: reduction in venous compliance + reduction in capillary permeability + inhibition of free radicals + inhibition of leukocytes → clinical effects: reduction in edema + functional symptoms (heaviness + heaviness + cramps) + improvement in microcirculation → Nicolaides 2018 - International Angiology (meta-analysis): MPFF → significant improvement in CVI symptoms (level of evidence B) + reduction in edema + Lyseng-Williamson 2003 - Drugs: MPFF → proven efficacy in stages C3-C4 → and as adjuvant in UVJ + Coleridge-Smith 2001 - European Journal of Vascular and Endovascular Surgery: MPFF + UVJ → improved healing of 32 % vs placebo → hydroxyethylrutosides (HR 0-β-HER - Venoruton): another venotonic flavonoid → similar properties + used in Europe + aminaftone + horse chestnut seed extract (Venostasin - escine): reduction of venous edema + Pittler 2006 - Cochrane: horse chestnut seed extract + IVC → edema reduction comparable to light compression → moderate quality data + red vine extract (Antistax) → ruscus aculeatus: reduces venous distensibility → venotonics in Canada: available without prescription + variable quality data → not reimbursed by RAMQ → complementary role to compression + no replacement for CVM; post-thrombotic syndrome (PTS) - prevention and treatment: PTS = sequelae of DVT → incidence 20-50 % after proximal DVT (Prandoni 2009 - Haematologica) → clinical picture: chronic edema + pain + heaviness + skin changes + UVJ → risk factors: proximal DVT (popliteal + femoral + iliac) + ipsilateral recurrence + obesity + advanced age + inadequate initial anticoagulation → prevention of TPS: adequate anticoagulation of DVT (duration and intensity) → class II compression stockings started within 24-48h after DVT diagnosis and continued 2 years → but: Brandjes 1997 - Lancet: class II stockings after DVT → 50 % reduction in TPS → confirmed by several studies → but: SOX trial (Kahn 2014 - NEJM): compression stockings after proximal DVT → no reduction in TPS at 2 years (placebo identical) → result controversial → discrepancy related to compliance with wearing stockings → recommendation to wear stockings after DVT remains cautious in latest guidelines (ACCP 2016 + ESC 2019) → treatment of established TPS: strong CVM + MPFF + physiotherapy + in case of residual deep venous obstruction (residual thrombus) → angioplasty + iliac vein stenting (IVUS-guided) → increasingly positive data; hygienic-dietary measures and prevention: elevation of lower limbs: elevated leg position (above heart level) × 30 min × 3-4 times/d → reduction of venous hypertension + symptoms → regular physical activity: walking + swimming + cycling → activation of calf muscle pump → reduction of reflux → contraindicated: prolonged static standing + prolonged sitting (legs crossed) + hot baths + prolonged exposure to heat → weight loss: obesity → increase in abdominal pressure → ilio-caval venous compression → IVC → loss of 5-10 % of weight → significant reduction in symptoms + pregnancy and IVC: increased blood volume + venous compression by the uterus → CVI in 40-70 % of pregnancies → wear class I-II compression stockings from the 1st trimester → continue postpartum until regression → no venotonics during pregnancy (insufficient data on fetal safety) → CVI and contraception: estrogen-progestin contraceptives → increased risk of DVT × 3-6 + aggravation of CVI → discuss an alternative contraceptive method if severe CVI + DVT history | Nicolaides 2018 - International Angiology (meta-analysis): MPFF → improvement IVC symptoms + Lyseng-Williamson 2003 - Drugs: MPFF → C3-C4 efficacy + Coleridge-Smith 2001 - EJVES: MPFF + UVJ → +32 % scarring vs placebo + Pittler 2006 - Cochrane: chestnut extract → edema reduction comparable light compression + Prandoni 2009 - Haematologica: SPT → incidence + FdR + Brandjes 1997 - Lancet: low class II after DVT → SPT reduction 50 % + Kahn 2014 - NEJM (SOX trial RCT): low after DVT → no SPT reduction (controversial result - limited compliance) + ACCP 2016 (Kearon - Chest): DVT guidelines → compression after DVT → conservative recommendation + SVS/AVF 2012 + EVF 2022 + NICE 2023 NG168: general measures + venotonics + Société française de phlébologie (SFP) + Lurie 2020 - Journal of Vascular Surgery: revised CEAP classification 2020 → international reference |
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Medical venous compression is the first-line treatment for all symptomatic chronic venous insufficiency - but SPI should always be measured before prescription to exclude arteriopathy obliterans : a SPI (systolic pressure index) of less than 0.8 contraindicates strong compression. In patients with venous ulcers, early removal of incompetent venous trunks (EVLA or RFA) accelerates healing and reduces recurrences, according to the results of the EVRA trial (NEJM 2018). Compression stockings should be worn every day, put on in the morning before getting out of bed, and changed every 6 months to maintain their effectiveness.
Situations requiring urgent medical attention
Warm redness + pain + indurated cord along a varicose vein + moderate fever → superficial thrombophlebitis → medical consultation within 24-48h → venous echo-Doppler → if close to saphenofemoral junction (<3 cm) → risk of DVT → anticoagulation → topical + oral NSAIDs + compression + if extensive + symptomatic → fondaparinux 2.5 mg/d × 45 days (Décousus 2010 - NEJM CALISTO trial).
Sudden unilateral edema of a lower limb + calf or thigh pain + heat + redness + Homans positive in a patient with known varicose veins or CVI → DVT until proven otherwise → urgent venous echo-Doppler (within 24h) → if DVT confirmed → immediate anticoagulation + compression after anticoagulation is instituted.
Chronic leg ulcer (>3 months without healing) with atonic necrotic base + compression resistance + intense nocturnal pain + absent lower limb pulses → probable arterial component or mixed arteriovenous ulcer → urgent IPS measurement → if IPS <0.6 → urgent vascular consultation → contraindication to strong compression → revascularization to be discussed.
Chronic venous ulcer + peri-ulcer cellulitis (>2 cm around the fundus + fever + leukocytosis + lymphangitis) + signs of sepsis (tachycardia + hypotension) → severe venous ulcer infection → medical emergencies → blood cultures + systemic antibiotic therapy (cloxacillin + or amoxicillin-clavulanate + or vancomycin if MRSA suspected) + local care + appropriate compression → hospitalization if signs of sepsis.
Consult at Clinique Omicron
Clinique Omicron's physicians assess chronic venous insufficiency according to the CEAP classification, measure SPI before prescribing compression, prescribe appropriate compression stockings and bands, refer to vascular surgeons or phlebologists for procedures (sclerotherapy + EVLA + RFA), manage venous ulcers in collaboration with specialized wound care nurses, and manage complications (thrombophlebitis + DVT). Consultations are available at several points of service in Quebec, and via telemedicine. To book an appointment, visit cliniqueomicron.ca.
The contents of this page are provided for information purposes only and do not replace the advice of a physician, vascular surgeon or phlebologist. A leg ulcer always requires specialized assessment to exclude an arterial component before applying strong compression.
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