Preventing recurrence of venous leg ulcers

Historically, recurrence of a venous leg ulcer has been common—most patients had multiple episodes. With improved access to optimal vein care (eg endovenous interventions), it is expected that venous leg ulcer recurrences will significantly reduce. Factors associated with recurrence include a history of deep vein thrombosis, failure to correct venous hypertension or a previous large ulcer.

The mainstay of preventive treatment is correction of venous hypertension. Long-term compression therapy is still recommended for patients with obstruction or deep venous insufficiency, use class III compression (defined in this guideline as 30 to 40 mmHg). For other patients, use class II compression (20 to 29 mmHg). If patients do not tolerate this level of compression, options include using a lower grade of compression, a combination of low compression stockings, a biomechanical device (eg Veinoplus) or long-term compression bandaging (elastic or inelastic).