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Combined Superficial and Perforator Venous Reflux With or
Without Deep Venous Disease and Skin Changes at Risk for
Venous Leg Ulcer (C4b) or Healed Venous Ulcer (C5)
➤ In a patient with skin changes at risk for venous leg ulcer (C4b) or
healed venous ulcer (C5) and incompetent superficial veins that have
reflux to the ulcer bed in addition to pathologic perforating veins
(outward flow of 500 ms duration, with a diameter of 3.5 mm) located
beneath or associated with the healed ulcer bed, we suggest ablation
of the incompetent superficial veins to prevent the development or
recurrence of a venous leg ulcer. (2-C)
➤ Treatment of the incompetent perforating veins can be performed
simultaneously with correction of axial reflux or can be staged with
re-evaluation of perforator veins for persistent incompetence after
correction of axial reflux. (2-C)
Pathologic Perforator Venous Reflux in the Absence of
Superficial Venous Disease, With or Without Deep Venous Reflux,
and a Healed or Active Venous Ulcer
➤ In a patient with isolated pathologic perforator veins (outward flow
of 500 ms duration, with a diameter of 3.5 mm) located beneath or
associated with the healed (C5) or active ulcer (C6) bed regardless of
the status of the deep veins, we suggest ablation of the "pathologic"
perforating veins in addition to standard compression therapy to aid
in venous ulcer healing and to prevent recurrence. (2-C)
Treatment Alternatives for Pathologic Perforator Veins
➤ For those patients who would benefit from pathologic perforator vein
ablation, we recommend treatment by percutaneous techniques that
include ultrasound-guided sclerotherapy or endovenous thermal
ablation (radiofrequency or laser) over open venous perforator surgery
to eliminate the need for incisions in areas of compromised skin. (1-C)
Infrainguinal Deep Venous Obstruction and Skin Changes at Risk
for Venous Leg Ulcer (C4b), Healed (C5) or Active (C6) Venous
Leg Ulcer
➤ In a patient with infrainguinal deep venous obstruction and skin
changes at risk for venous leg ulcer (C4b), healed venous leg ulcer
(C5), or active venous leg ulcer (C6), we suggest autogenous venous
bypass or endophlebectomy in addition to standard compression
therapy to aid in venous ulcer healing and to prevent recurrence. (2-C)
