Chronic Venous Insufficiency & Venous Ulcers

CVI is common, especially in older adults. Venous ulcers are the most common type of leg ulcer.

• Early: spider or varicose veins, and swelling at the end of the day.
• Skin changes: brown or reddish skin near the ankles, itchy, scaly skin (stasis dermatitis), or hard, tight skin.
• Healed ulcer: the skin has closed, but the area is fragile and can open again.
• Active venous ulcer: an open sore that needs regular wound care.

• A past blood clot in the leg (DVT), which can damage vein valves
• Varicose veins
• Family history of vein problems
• Getting older
• Being overweight
• Standing or sitting for long periods
• Pregnancy, especially more than one
• Leg injury, or limited ankle movement that weakens the calf muscle pump

• Swelling in the lower legs and ankles, worse at the end of the day and better after rest with legs raised
• Heavy, achy, tired or crampy legs
• Varicose veins
• Itchy, dry, scaly or weepy skin near the ankles
• Brown, red or purple skin color around the ankles
• Skin that feels hard, tight or shrunken around the lower leg
• An open sore, often on the inside of the ankle, with uneven edges and some drainage. It may be only mildly painful.
• At your visit, your provider looks at both legs, measures swelling, checks the skin, measures and examines any wound, checks for signs of infection, and checks the pulses in your feet.

CVI is diagnosed from your history and exam.

Before starting strong compression, we check blood flow to your feet with an ankle-brachial index (ABI) or screening Doppler in our office, because compression can be unsafe if the arteries are narrowed.

A venous duplex ultrasound shows how blood flows in the veins and checks for blood clots. We don't do imaging at our office; we refer you to a vascular clinic or imaging center and review the results with you.

For a wound that isn't healing, your provider may check for infection, diabetes or other causes.

Treatment helps sores heal and keeps new ones from forming. Your plan may include:

• Compression: wraps, bandages or stockings fitted for you. This is the most important treatment for healing venous ulcers and preventing them from returning.
• Wound care at Royal Wound Care: cleaning the sore, removing dead tissue when needed, and using the right dressings. Home nursing through our partners can help with dressing changes between visits.
• Raising your legs above heart level several times a day.
• Walking and ankle exercises to help the calf muscles pump blood.
• Daily skin care: wash gently, moisturize dry skin, and treat itchy, irritated skin.
• Treating infection if one develops.
• Vein procedures by a vascular specialist for some people, which can lower the chance of ulcers coming back.

Venous ulcers can take weeks to months to heal. Wearing compression as directed makes a big difference.

Ulcers can come back, so most people need to keep wearing compression stockings long term after the sore heals.

Your primary care team at Moaddel Medical looks for the cause of your leg swelling and skin changes, checks blood flow in our office before compression, and refers you to a vascular clinic when imaging or vein treatment is needed.

For venous ulcers and other slow-to-heal wounds, Royal Wound Care, part of Moaddel Medical, provides full-scope wound care in house alongside your primary care team. Our networking partners offer home nursing for dressing changes and medication management. If you have a new or worsening leg sore, call us for a same-day visit.

We're at 7230 Medical Center Dr, Suite 100, West Hills, CA 91307.