Etiology and Anatomic Distribution of Venous Disease in Patients with Venous Ulcers

Leg ulcers due to chronic venous disease affect 0.5 to 1% of Western populations. Reflux and/or obstruction of the lower extremity veins are the underlying pathophysiological mechanisms. The superficial venous system is the most common site of venous insufficiency in patients with chronic venous disease; however, the incidence of deep venous insufficiency is increased in patients with venous ulcers. Skin damage is most often associated with multi-system incompetence, and it is rare with deep venous reflux alone. Only 30 to 50% of limbs with ulceration have a documented episode of deep vein thrombosis. Recent developments in the diagnosis of venous disease have allowed more accurate identification of the malfunctioning venous segments and a more rational application of surgical treatment.