Endovenous intervention and surgery

Early referral to a vascular specialist is strongly recommended for patients with a venous leg ulcer. The aim of vascular intervention is to assist ulcer healing and reduce recurrence. First-line endovenous therapy is endothermal ablation, including endovenous laser and radiofrequency ablation. Endothermal ablation can be used for both axial and perforator vein reflux. Second-line therapy is ultrasound guided foam sclerotherapy. Third-line therapy is open surgery.

Patients with chronic venous disease and proximal obstruction (inferior vena cava or iliac) should be considered for angioplasty and stent recanalisation to aid healing and prevent recurrence of venous leg ulcers; seek specialist advice.