Treatment
22
Figure 1. Treatment Algorithm
Venous Ulcer
Diagnostics
a
clarification: +/+ ulcer = treat both; no ulcer = treat only superficial.
Proposed algorithm for operative and endovascular treatment of patients with venous
leg ulcer (VLU) based on involved anatomic venous system and presence of venous
reflux or obstruction. e risk-to-benefit ratio is weighed for those procedures with
more risk (lower, moderate, higher) considered later in the treatment when the benefit
is similar.
+ obstruction
+ perforator + superficial
+ proximal
Rx Endo (open)
a
Rx
Endo
Failed/not option
Reevaluate
+ Superficial/
perforator
Valvular
reconstruction
Failed/not option
Reevaluate
+ proximal + infrainguinal
Bypass
unilateral
Bypass
endophlebectomy
Not option/
Reevaluate
Bypass
bilateral
Highest
risk
Similar risk/
benefit:
Less risk
+ reflux
Deep reflux
Similar risk/
benefit:
Moderate risk
–
+
+/+
+/–
+/–
