Varicose Veins as a Cause of Non-Healing Ulcers: Treatment Using Endovenous Techniques

Varicose Veins as a Cause of Non-Healing Ulcers: Treatment Using Endovenous Techniques


Varicose veins are abnormal dilation of the superficial veins, causing chronic venous insufficiency. It causes non-healing ulcers in the lower limbs. 


Venous ulcers develop due to prolonged venous hypertension. Venous hypertension leads to tissue damage and poor wound healing. Multiple treatments have been used to treat venous ulcers, such as compression therapy, wound care, and surgical methods. These help to manage symptoms but often fail to treat the underlying cause, leading to persistent or recurrent ulcers.



Endovenous treatment of varicose veins and venous ulcers has become famous lately. It works by eliminating the venous reflux directly. Varicose veins contribute to non-healing ulcers, and endovenous treatment can promote healing and prevent recurrence.


Varicose Veins Cause Non-Healing and Recurrent Ulcers


Venous ulcers develop due to chronic venous insufficiency. It results from nonfunctional venous valves. When these valves fail, blood stays in the legs. It leads to increased venous pressure (venous hypertension). High pressure damages capillaries, reduces nutrient delivery to tissues and causes chronic inflammation.

 These changes lead to skin breakdown due to poor circulation and increased inflammation. Chronic wound formation results due to insufficient oxygenation and nutrients.

Ulcer persistence thus results from continuous venous hypertension.


Venous ulcers primarily form around the ankle and are characterized by irregular edges, exudative wounds, and surrounding skin changes like hyperpigmentation.




Why Conservative Treatments is not sufficient

Compression Therapy


Compression therapy is mainly used as a treatment for venous ulcers. It reduces edema and improves blood return to the heart. However, compression alone does not correct venous reflux, and ulcers often recur once therapy stops.

Wound Care and Topical Treatments

Dressings, debridement, and infection control help manage ulcers but do not treat the root cause venous hypertension. Many patients experience slow healing and frequent ulcer recurrence without definitive venous intervention.



These methods provide symptomatic relief but do not solve the underlying venous reflux. So, endovenous treatment is an essential component of long-term ulcer management.






Endovenous Treatment: A New Approach for  Non-Healing Venous Ulcers


Endovenous treatments directly deal with the cause of ulcers. It aims to treat incompetent veins and venous hypertension. Improved venous circulation further helps treat ulcers. The most common endovenous techniques used   include:


Endovenous Laser Ablation (EVLA)

Laser treatment uses laser energy to treat incompetent veins. It is done under local anesthesia using ultrasound guidance.


Procedure:


A catheter is inserted into the affected vein, and a laser fiber is inserted. Laser energy is delivered to the vein, causing it to close and cause fibrosis.

Blood moves to healthier veins, reducing venous pressure.


Benefits for Ulcer Healing:

  • Reduces venous reflux, decreases ulcer size, and promotes healing.

  • Minimally invasive with faster recovery than surgery.

  • Effective in both superficial and perforator veins, contributing to ulcer formation.


Radiofrequency Ablation (RFA)


RFA is similar to laser treatment but uses radiofrequency energy for vein damage and closure.

A catheter is inserted into the vein, and radiofrequency energy is applied, heating the vein wall and causing closure.


The body gradually absorbs the vein, rerouting blood to functional veins.


Why Choose RFA?

  • Less post-procedure discomfort compared to EVLA.

  • Lower risk of skin burns due to controlled heating.

  • It is equally effective as laser treatment for ulcer healing and venous insufficiency.


Foam Sclerotherapy (FS)


FS injects a foam sclerosant into varicose veins to induce fibrosis and lead to vein closure. It is often used for residual or recurrent veins post-EVLA or RFA.


Procedure:

Foam sclerosant is injected into the diseased vein using ultrasound guidance.

 Blood is redirected to healthier veins.


Advantages for Venous Ulcers:

  • It can be used on small perforator veins that contribute to ulcer formation.

  • It is non-invasive and can be repeated if necessary.

  •  It is suitable for patients who cannot undergo EVLA or RFA.


Endovenous Mechanochemical Ablation (MOCA)


MOCA is a newer technique that combines mechanical agitation and chemical sclerosant to close veins without thermal energy.


Benefits:

  • It is effective in below-knee varicosities where laser and Rfa cause nerve injury.

  • No heat-based injury (lower risk of nerve damage or burns).

  • Less pain and bruising compared to EVLA and RFA.

  • Effective for large varicose veins associated with venous ulcers.


Effectiveness of Endovenous Treatment in Venous Ulcers


  • Endovenous ablation improves ulcer healing rates compared to conservative treatments alone.

  • MOCA therapy, EVLA, and RFA have ulcer healing rates of up to 90-95 % within 12 months.

  • Combined treatment (EVLA + compression therapy) results in faster wound closure and lower recurrence rates.

  • Endovenous treatments help reduce pain, improve mobility, and improve the quality of life after treatment.

  • Endovenous treatments also help prevent future ulcers, making them better than conventional methods in long-term management.


When to Consider Endovenous Treatment


Patients with non-healing venous ulcers should be evaluated for endovenous treatment if they have:

  • Persistent venous ulcers (>6 weeks) despite compression therapy.

  •  Evidence of superficial or perforator vein reflux on Doppler ultrasound.

  • Recurrent venous ulcers despite previous wound care.

  • Large, painful ulcers that impair daily activities.


Early endovenous therapy treatment can reduce healing time, prevent complications, and improve patient outcomes.


Conclusion


Varicose veins are a prominent cause of non-healing venous ulcers. Many traditional treatments have been used, but compression therapy alone often does not work well. Endovenous treatments such as laser, radiofrequency, Sclerotherapy, and MOCA therapy offer compelling and invasive solutions. It directly targets venous reflux. These interventions improve ulcer healing, reduce recurrence rates, and enhance quality of life.


Combining endovenous therapy with compression and wound care can help in even faster ulcer healing. Long-term venous health and quality of life can be improved by reducing the burden of chronic venous disease.




















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