Practical Management of Venous Leg Ulcers: Guideline-Based Diagnosis, Compression, and Venous Intervention
10.37923/phle.2025.23.2.67
- Author:
Jungmin YOON
1
;
Yunju LEE
;
Jaeeun YOU
;
Yearim CHA
;
Jiyoon PARK
;
Yun-Seo OH
;
Seungmin LEE
;
Hyangkyoung KIM
Author Information
1. Ewha Womans University College of Medicine, Seoul, Korea
- Publication Type:Review Article
- From:
Annals of phlebology
2025;23(2):67-77
- CountryRepublic of Korea
- Language:English
-
Abstract:
Venous leg ulcers (VLUs) represent the most advanced manifestation of chronic venous disease and arise from sustained ambulatory venous hypertension due to superficial reflux, deep venous obstruction, or both. Accurate etiologic assessment is essential, with duplex ultrasound serving as the primary tool to identify axial reflux, perforator incompetence, and signs of proximal outflow obstruction in accordance with contemporary ESVS and SVS/AVF guidelines. Compression therapy remains the foundation of treatment, with inelastic or adjustable compression systems providing the most effective pressure reduction and edema control. Optimal wound care—including moisturebalancing dressings, debridement, and judicious use of antimicrobials—supports timely epithelialization. Adjunctive pharmacologic agents such as micronized purified flavonoid fraction, pentoxifylline, and sulodexide may further enhance healing. Early correction of superficial reflux accelerates healing and reduces recurrence, as demonstrated in the Early Venous Reflux Ablation trial. Iliac venous obstruction should be considered in nonhealing or recurrent ulcers, with IVUS-guided stenting appropriate when significant stenosis is confirmed. Integrating guideline-directed venous intervention, optimized compression, and structured wound care is central to improving long-term outcomes in VLU management.
