This is a guest post by Eddie Chaloner.
A lot of older people worry about developing ulcers on the legs in later life. This is a common problem in the elderly and is a major public health problem in the UK. Most of the leg ulcers seen in the UK are caused by problems in the veins of the legs. Usually these vein problems will have been present for many years before a leg ulcer develops.
This is a shame as many vein problems are treatable before they get to the stage of creating an ulcer and, effective treatment can significantly reduce the risk of an ulcer happening.
What causes leg ulcers?
Vein ulcers occur because of high pressure in the superficial veins of the legs – those are the veins just underneath the skin. High vein pressure can happen as a result of two basic processes – either a failure in specific valves in the superficial veins (so called varicose veins), or damage to the deep veins of the legs for example after a Deep Vein Thrombosis (DVT).
High pressure in the leg veins is at its worst at the ankle level because this point is the lowest point of the column of blood in the vein going back up the leg. There are several theories as to why the high vein pressure causes the skin damage, which eventually leads to the ulceration. Doctors think that substances in the blood are forced out of the vein and into the space just under the ankle skin. This sets up an inflammation process, which makes the ankle skin deteriorate.
The first sign of this inflammation is dryness of the skin, usually over the anklebone, on the inside part of the leg. There is no flesh between the skin and bone in this area, which makes the skin a bit more vulnerable than in other areas of the leg. The dryness can lead to an itchy sensation (often called venous eczema) and to a brown discolouration of the skin – this is called by doctors ‘haemosiderin deposition’ or lipodermatosclerosis’ – both of these terms are just long words for skin damage caused as a result of vein damage.
What should I do if I have these symptoms?
This is certainly the time to get things checked out by a doctor – preferably a vein specialist – because this is the time to intervene with surgery in an attempt to halt the skin damage and prevent an ulcer occurring. The crucial point is that it is often quite easy and quick to prevent an ulcer breaking out, but, once an ulcer is established it is often very difficult to heal and requires months of special treatment and compression bandaging. Sometimes, ulcers take years to heal and there are some that never heal completely. Vein ulcers are an unpleasant and debilitating condition, which can cause older people to lose their mobility and independence and become isolated indoors as a result of pain from the ulcer. It makes much more sense to prevent an ulcer than to try and treat it once one is established.
What does treatment involve?
Fortunately preventative treatment is much better in 2012 than it was even 10 years ago. The first important step is to scan the veins of the leg to establish where the problems are with the valves and what needs to be done to fix them.
Usually something can be done by means of minimally invasive surgery to fix the leaky vein in the leg. Minimally invasive vein surgery has come a long way in the last 10 years and is almost always done under local anesthetic without needing to put the patient to sleep – in other words a bit like going to the dentist. There are several different techniques used but most of them rely on heat based mechanisms such as endovenous lasering or Venous closure to seal the inside of the vein without needing to cut the leg at all. The devices used to seal the veins are introduced through very tiny nicks in the skin under the control of an ultrasound probe.
Being able to treat veins in this way under local anesthetic is of particular advantage in elderly patients who may have lots of other medical problems and for whom a general anesthetic may be risky. The new techniques work very well to seal the vein and this reduces the chance of vein ulceration very substantially.
Author Bio: Eddie Chaloner is a consultant vascular surgeon at Radiance Health, a vein treatment centre specialising in the latest minimally invasive procedures for treating varicose veins, thread veins, and DVT.