title: Emerging treatment options for venous ulceration in today's wound care practice.
abstract: Lower-extremity ulcers represent the largest group of ulcers presenting to an outpatient wound care clinic and, of those, ulcers due to venous insufficiency and venous hypertension make up the largest subgroup of these ulcers. Interventions for chronic venous ulcers have evolved to painless, minimally invasive, office-based procedures performed under local anesthesia. Recent advances in the endovascular management of lower-extremity superficial venous insufficiency have the potential to significantly enhance initial and long-term management of these patients, as minimally invasive procedures provide faster recoveries and fewer procedural risks. Early intervention for venous insufficiency has been shown to significantly decrease long-term ulcer recurrence rates, and may increase healing of venous ulcers as well.
  
  
  OBJECTIVE
  The purpose of this review and algorithm is to enhance understanding of venous ulceration and its underlying causes. Venous anatomy and pathophysiology will be reviewed. The etiology of chronic venous ulceration will be examined. Current practice guidelines and clinical outcomes will be reviewed. The newest treatment options, including minimally invasive therapy will be described. The current literature will be reviewed. A new algorithm for treatment that integrates the endovascular treatment of venous insufficiency into the current standard care for venous leg ulceration will be proposed.
  
  
  METHODS
  A literature review was performed to review all current treatments for venous ulceration. Treatments that have Level I evidence (with a grade of recommendation of A or B) to support their use for venous leg ulceration were selected for incorporation into a new treatment algorithm. The level-of-evidence and strength-of-recommendation scheme used in the algorithm is based upon the system used by the Wound Healing Society in its chronic wounds clinical practice guidelines.
  
  
  CONCLUSIONS
  It is intended that this new algorithm and approach to treatment will improve the immediate care of venous leg ulcer patients, reduce recurrence rates, increase patient satisfaction, and potentially expedite initial wound healing in the outpatient wound clinic setting.
authors.affiliation: University of Hawaii; John A Burns School of Medicine, Honolulu, Hawaii, USA.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Kistner
authors.forename: Randy
authors.initials: R
authors.lastname: Shafritz
authors.forename: Karl R
authors.initials: KR
authors.lastname: Stark
authors.forename: Robert A
authors.initials: RA
authors.lastname: Warriner
mesh_terms: D000465:Algorithms; D019317:Evidence-Based Medicine; D006801:Humans; D014647:Varicose Ulcer / Q000503:physiopathology / Q000628:therapy*