Venous stasis ulcers are a common yet severe and chronic condition primarily affecting the lower legs, particularly around the ankles. These open sores develop when the veins in the legs fail to circulate blood properly, leading to increased pressure and fluid buildup. Over time, this pressure weakens the surrounding skin and tissues, causing ulcers that are slowly healing. The condition is often linked to chronic venous insufficiency. In this condition, the veins struggle to return blood to the heart, leading to various complications, including skin breakdown and open wounds.

Venous stasis ulcers are more prevalent in older adults and individuals with a history of vein-related disorders, such as varicose veins or deep vein thrombosis (DVT). Understanding the causes, symptoms, and treatment options for these ulcers is critical to managing the condition effectively and improving patient outcomes. Early intervention and proper wound care can significantly reduce the risk of infection and further complications, helping patients achieve better long-term results.

What Is Venous Stasis Ulcer?

The formation of a venous stasis ulcer begins with venous insufficiency, a condition in which the valves in the veins fail to function correctly. Usually, these valves help push blood upward against gravity toward the heart. However, blood can pool in the lower legs when they weaken or become damaged, leading to increased pressure within the veins. This excess pressure causes fluid to leak out of the veins and into surrounding tissues, damaging the skin and creating a site where ulcers can develop.

A venous stasis ulcer usually starts with visible skin changes, such as discoloration or thickening, followed by open sores. These ulcers are often shallow, with irregular edges, and are surrounded by discolored or swollen skin. They can be painful and prone to infection, further delaying healing.

Venous stasis ulcers are considered a serious medical condition due to their chronic nature and potential complications, such as infection or tissue necrosis. The ulcer may enlarge without proper treatment, and the healing process may take months or even years.

Causes of Venous Stasis Ulcer

Commonality of Venous Stasis Ulcer

Venous stasis ulcers are among the most common chronic leg ulcers, particularly among older adults and those with vein-related issues. It is estimated that venous stasis ulcers account for 70-90% of all lower extremity ulcers, affecting around 1-3% of people over 60. This condition tends to become more prevalent with age and in individuals with a history of venous disorders, including varicose veins and deep vein thrombosis (DVT).

Key Causes of Venous Stasis Ulcer Development

The primary cause of a venous stasis ulcer is chronic venous insufficiency (CVI), a condition where the veins in the legs cannot effectively return blood to the heart. Over time, this increases pressure in the veins and surrounding tissues, setting the stage for ulcer formation. The following factors contribute significantly to the development of venous stasis ulcers:

• Venous Insufficiency: When the one-way valves in the veins become damaged or weakened, they allow blood to flow backward and pool in the lower legs. This pooling increases venous pressure and leads to fluid leaking into nearby tissues, weakening the skin and making it susceptible to ulcers.
• Deep Vein Thrombosis (DVT): A previous history of blood clots in the deep veins of the legs can cause long-term damage to the veins, contributing to venous insufficiency and increasing the risk of developing a venous stasis ulcer.
• Varicose Veins: Enlarged, twisted veins near the skin's surface indicate poor blood flow and are often linked to venous insufficiency. Due to chronic pressure and fluid retention in the lower legs, people with varicose veins are likelier to experience venous stasis ulcers.
• Obesity: Excess weight places additional pressure on the leg veins, making it more difficult for blood to flow back to the heart. This can worsen venous insufficiency and contribute to the development of ulcers.
• Prolonged Standing or Sitting: Occupations or lifestyles involving standing or sitting for long periods can reduce leg circulation. This can lead to blood pooling and increased pressure in the veins, raising the risk of venous stasis ulcers.
• History of Leg Injury or Surgery: Trauma to the legs, such as fractures or surgeries, can cause long-term damage to the veins or lymphatic system, contributing to poor blood circulation and increasing the likelihood of ulcer formation.
• Aging: As people age, the elasticity of their veins decreases, and vein valves may weaken. This natural degeneration of the veins with age is a significant factor in the prevalence of venous stasis ulcers among older adults.

While the primary cause of a venous stasis ulcer is poor circulation due to venous insufficiency, a combination of factors, such as lifestyle, medical history, and age, often lead to the development of these chronic wounds. Understanding the causes is crucial for effective prevention and management of this condition.

Venous Ulcer Symptoms

Early Symptoms of Venous Stasis Ulcer

In the initial stages of a venous stasis ulcer, the skin on the lower legs, particularly around the ankles, shows poor circulation. These early symptoms include:

• Redness: One of the first signs of a venous stasis ulcer is the development of red or purplish patches on the skin, usually around the ankles. This discoloration occurs due to the pooling of blood and increased pressure in the veins, leading to inflammation in the surrounding tissues.
• Itching: As the skin becomes irritated from the buildup of fluid, patients often experience a persistent itching sensation. Scratching can further damage the fragile skin, increasing the risk of ulcer formation.
• Skin Discoloration: The affected area may become darker brownish over time. This discoloration, called hemosiderin staining, occurs when red blood cells leak out of the veins and break down in the tissues, leaving behind iron deposits. This is often a sign of prolonged venous insufficiency and signals the risk of an ulcer developing.
• Tight or Shiny Skin: The skin over the affected area may become tight, shiny, or slightly firm due to fluid retention in the surrounding tissues, a condition known as edema.

Advanced Symptoms of Venous Stasis Ulcer

If the early symptoms of a venous stasis ulcer are not addressed, the condition can progress to more severe stages, where open wounds and other serious complications develop. Advanced symptoms include:

• Pain: As the ulcer forms, patients often experience increasing levels of discomfort. The pain can range from mild to severe, especially when the ulcer becomes infected or inflamed. The pain typically worsens when standing or walking, as gravity causes more blood to pool in the legs.
• Open Wounds: One of the hallmark signs of a venous stasis ulcer is the appearance of an open sore, usually around the inner side of the ankle. Depending on the severity, the wound often has irregular edges and may be shallow or deep. The surrounding skin is usually discolored and may be swollen.
• Swelling (Edema): Fluid buildup in the lower legs leads to noticeable swelling. The ankles and calves may become visibly enlarged and feel tight. This swelling further impairs blood flow, making it more difficult for the ulcer to heal and increasing the risk of infection.
• Exudate (Fluid Drainage): In more advanced cases, the ulcer may produce clear or yellowish fluid that seeps from the wound. This is due to the body’s attempt to rid itself of the excess fluid buildup in the area. If the drainage becomes foul-smelling or changes color, it could indicate an infection.
• Thickened or Hardened Skin: Over time, the skin surrounding the ulcer may become thick, leathery, or stern—this condition, known as lipodermatosclerosis, results from chronic inflammation and poor circulation.

Without proper treatment, a venous stasis ulcer can persist for months or even years, leading to complications such as infection, cellulitis (infection of the deeper skin layers), or, in severe cases, tissue necrosis. Recognizing early and advanced symptoms is essential for timely intervention and effective treatment.

Diagnosis and Coding for Venous Stasis Ulcer

How Venous Stasis Ulcers Are Diagnosed

Diagnosing a venous stasis ulcer typically involves a combination of clinical evaluation and diagnostic tests to confirm the underlying cause and severity of the condition. A healthcare professional will follow these steps to diagnose the ulcer accurately:

• Medical History and Physical Examination: The first step in diagnosing a venous stasis ulcer is obtaining a detailed medical history. The clinician will ask about symptoms such as swelling, pain, or skin changes and inquire about any history of venous disorders (e.g., varicose veins, deep vein thrombosis, or prior leg injuries). During the physical exam, the clinician will visually inspect the affected leg(s), focusing on the appearance of the skin, the presence of discoloration, and any open sores.
• Visual Examination: The visual examination is crucial in identifying early signs of a venous stasis ulcer. The doctor will look for typical indicators such as redness, hemosiderin staining (brown discoloration), swelling, and the characteristic appearance of an open ulcer near the ankle. The ulcer is often shallow with irregular borders, and the surrounding skin may show signs of chronic venous insufficiency, such as thickening or shiny, tight skin.
• Doppler Ultrasound: A Doppler ultrasound is commonly performed to assess blood flow in the veins and confirm venous insufficiency diagnosis. This noninvasive test uses sound waves to measure the speed and direction of blood flow in the veins. It helps determine whether the valves in the veins are functioning correctly and if any obstruction or reverse blood flow contributes to the development of the ulcer.
• Venography: In more complex cases where additional detail is needed, venography may be performed. This imaging technique involves injecting a contrast dye into the veins, allowing the clinician to visualize the venous system using X-ray or other imaging modalities. Venography helps identify any blockages, clots, or anatomical abnormalities contributing to venous insufficiency and the formation of ulcers.
• Ankle-Brachial Index (ABI): A clinician may use the Ankle-Brachial Index test to rule out arterial involvement (which can complicate healing). This simple test compares the blood pressure in the ankle with the blood pressure in the arm to assess arterial circulation in the legs. While venous stasis ulcers are primarily caused by venous insufficiency, assessing arterial health is essential for determining appropriate treatment.

Venous Stasis Ulcer ICD-10 Code

Accurate classification of conditions like venous stasis ulcers is essential for proper documentation, billing, and treatment planning in medical coding. The ICD-10 (International Classification of Diseases, 10th Edition) provides specific codes for different types of ulcers, including venous stasis ulcers.

• The primary ICD-10 code used for a venous stasis ulcer is I87.2. This code is associated with chronic venous insufficiency (CVI) of the leg with ulceration, which includes any ulcer resulting from venous insufficiency, such as venous stasis ulcers.
• Additional ICD-10 codes may be used depending on the specifics of the ulcer, including:
• L97.2-L97.4: These codes describe non-pressure chronic ulcers of the lower extremities (excluding the foot) and are used to provide more detail about the location and severity of the ulcer. For example, codes in this range specify if the ulcer is on the calf or ankle or is in a more advanced stage with necrosis or exposure of deeper tissues.
• I83.0-I83.2: These codes cover varicose veins with ulceration, which may also be relevant if the ulcer is associated with varicose veins in the lower legs.

The appropriate selection of ICD-10 codes ensures that the venous stasis ulcer is classified correctly based on its underlying causes and specific characteristics. This coding not only aids in accurate medical documentation but also facilitates communication between healthcare providers, insurers, and patients regarding the diagnosis and management of the condition.

Venous Stasis Ulcer Treatment Options

Conservative Treatments for Venous Stasis Ulcers

Treating a venous stasis ulcer typically begins with conservative methods to improve blood circulation, manage symptoms, and promote wound healing. These approaches are often the first line of defense and can be highly effective when applied consistently.

Compression Therapy:

• Compression therapy is the cornerstone of conservative treatment for venous stasis ulcers. It involves applying pressure to the affected leg with compression bandages or stockings. This pressure helps improve blood flow by reducing blood pooling in the veins and aiding venous return to the heart.
• Compression stockings are available in various strengths, depending on the severity of venous insufficiency. Patients are typically advised to wear them daily, especially when standing or walking, to prevent further venous damage and promote ulcer healing.
• Sometimes, intermittent pneumatic compression (IPC) devices may be used. These devices use air pumps to periodically inflate and deflate a sleeve wrapped around the leg, helping stimulate blood flow and reduce swelling.

Wound Care:

• Proper wound care is essential for managing a venous stasis ulcer and preventing infection. This involves regularly cleaning the ulcer, applying appropriate dressings, and protecting the wound from further trauma.
• Moist wound healing is commonly recommended. The wound is kept slightly moist with specialized dressings to promote tissue regeneration and prevent the formation of scabs, which can delay healing.
• Antimicrobial dressings may be used if the ulcer shows signs of infection or is at risk of infection. These dressings contain agents like silver or iodine to reduce bacterial growth.
• Regular debridement, where dead or damaged tissue is removed from the ulcer, may also be necessary to encourage healthy tissue growth and speed up healing.

Lifestyle Changes:

Specific lifestyle changes can significantly improve the outcomes of patients with venous stasis ulcers when used with medical treatments.

• Elevating the legs above heart level for several hours each day can help reduce swelling by improving venous return and lowering pressure in the legs.
• Exercise, particularly low-impact activities like walking, can stimulate circulation in the legs and help strengthen the calf muscles, which pump blood back toward the heart.
• Maintaining a healthy weight is also critical, as excess body weight increases the pressure on the veins, worsening venous insufficiency and slowing ulcer healing.

Advanced Treatments for Venous Stasis Ulcers

Advanced treatments may be necessary when conservative treatments are insufficient or if the ulcer is particularly severe. These include surgical interventions, medications, and specialized care to address the underlying venous issues and promote ulcer healing.

Surgery:

Surgical procedures may be required to correct the underlying venous insufficiency for more severe cases of venous stasis ulcers. Standard surgical options include:

• Vein ablation: This procedure involves using heat (radiofrequency or laser) to close off damaged veins. By sealing off the malfunctioning vein, blood is rerouted through healthier veins, improving circulation and reducing venous pressure in the leg.
• Vein stripping or ligation: In this procedure, problematic veins (typically varicose) are tied off and removed to alleviate venous insufficiency. This helps reduce pressure on the veins and promotes ulcer healing.
• Skin grafting: In cases where the ulcer is large or fails to heal with other treatments, skin grafting may be necessary. This involves transplanting healthy skin from another body area to cover the ulcer and encourage new tissue growth.

Medications:

• If a venous stasis ulcer infects, topical or systemic antibiotics may be prescribed. Treating infection is crucial, as it can significantly delay healing and lead to complications such as cellulitis or sepsis.
• Pentoxifylline, a drug that improves blood flow by reducing blood viscosity, is sometimes combined with compression therapy to accelerate healing. It benefits patients who cannot tolerate compression or have more severe ulcers.
• Vasodilators and antiplatelet agents may also improve circulation and prevent blood clotting, especially in patients with coexisting conditions like deep vein thrombosis (DVT).

Specialized Wound Care Clinics:

• Patients with chronic or non-healing venous stasis ulcers may benefit from care at a specialized wound care clinic. These clinics offer advanced treatment options, including hyperbaric oxygen therapy, where patients are exposed to pure oxygen in a pressurized chamber to enhance healing.
• Negative pressure wound therapy (NPWT), also known as wound vacuum-assisted closure (VAC), is another option. This involves placing a vacuum-sealed dressing over the ulcer to remove excess fluid, reduce swelling, and promote faster healing by increasing blood flow.
• Some clinics also offer growth factor therapy or biological dressings that use bioengineered skin substitutes to stimulate the healing process in difficult-to-treat ulcers.

Conclusion

Early venous stasis ulcer treatment is crucial to prevent complications and promote faster healing. When left untreated, these ulcers can lead to infections, prolonged pain, and, in severe cases, tissue death. By addressing the condition at the onset of symptoms—such as redness, swelling, and skin discoloration—patients can significantly improve their chances of recovery. Conservative treatments like compression therapy and wound care can help manage the ulcer and improve circulation, allowing the wound to heal more quickly and reduce the risk of long-term damage.

If you notice any symptoms of a venous stasis ulcer, such as persistent swelling, skin changes, or open sores on your lower legs, you must seek medical consultation promptly. Early diagnosis and intervention enhance healing and prevent more severe complications from developing. Don’t wait for symptoms to worsen—reach out to a healthcare provider for proper evaluation and treatment to protect your health and improve your quality of life.