Venous Ulcer Treatment
Dallas Texas

Stubborn wounds
that won’t heal?

We treat
the source.

Stubborn wounds
that won’t heal?

We treat the source.

Venous Ulcer
Treatment Dallas Texas

Venous ulcers develop when blood flow is seriously impaired in the major veins of the leg. They typically form on the back of the lower leg between the mid-calf and the ankle bone, and are usually accompanied by skin discoloration, skin hardening, itchiness, and leg pain.
The goal of venous ulcer treatment is to restore healthy flow to the veins. While less severe vein disease can usually be addressed with superficial vein closure, venous ulcers often have deep vein obstructions that must be addressed as well to allow the leg to heal. Venous ulcer treatment at Interventional and Vascular Care in Dallas, Texas is provided by a Vascular Specialist that is trained in superficial vein closure and deep vein revascularization.

Venous Ulcer Treatment in Dallas, TX

Dr. Aaron Fritts, MD

Interventional & Vascular Specialists

Dr. Aaron Fritts is a board-certified Vascular & Interventional Radiologist that specializes in minimally invasive venous ulcer treatment in Dallas, Texas. Dr. Fritts is well-versed in vascular conditions, and has found passion in providing minimally invasive treatment for individuals suffering from serious vein disease. He was recently selected as a SuperDoctors Rising Star and has been voted one of D-Magazine’s best doctors in Dallas. Read full bio.

Dr. Aaron Fritts Interventional and Vascular Care Google Review Score
Venous ulcer treatment Dr. Aaron Fritts in Dallas, TX interventional vascular specialist

“From the moment I setup the initial appointment to speak with Dr. Fritts, to after my final procedure, the entire staff was phenomenal.”

– Erin in Dallas, TX

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“Dr. Fritts gave me all the time I needed to understand and feel comfortable with the procedure…He has a healer’s way about him. Highest recommendation.”

– Rod in Dallas, TX

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Venous Ulcer Treatment in Dallas, TX

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Living With Venous Leg Ulcers

Venous ulcers are the most severe manifestation of a condition called chronic venous insufficiency. Venous insufficiency is a broad term in medicine that is used to describe any vein abnormality that causes insufficient blood through the veins of the leg.

In its least severe form, venous insufficiency can cause medically insignificant spider veins, but as the disease progresses, varicose veins may develop and the affected leg(s) may become swollen and painful. As more veins are affected and blood flow is further compromised, the lower half of the leg can undergo major changes in appearance and ulcers can develop. In most individuals with venous insufficiency this disease process takes place over several years, and many cases aren’t symptomatic until later stages of disease.

Venous ulcer development on legs of patient with venous insufficiency

Deep and Superficial Veins – When we talk about veins in the legs, we tend to talk about them in two categories: deep and superficial. The deep veins sit deep within the leg, and are the main channel by which blood travels from the legs back to the heart. On the other hand, superficial veins run closer to the surface of the leg and drain blood into the deep veins. The superficial veins can be seen as bulging varicose veins in the early stages of venous insufficiency.

Deep and superficial veins are connected by deep-superficial junctions and perforator veins. This connectivity is important because flow problems in the deep veins can cause flow problems in the superficial veins and vise versa.

    Patient with venous ulcer from venous insufficiency in Dallas, TX

    There are multiple ways in which venous insufficiency can develop, and venous ulcers are often the manifestation of multiple sources of venous insufficiency.

    Reflux – Vein reflux is a medical phrase that is used to describe when blood flows backwards in a vein. Healthy veins have one-way valves that prevent back flow, but when these valves fail, blood accumulates in the affected vein, increasing pressure and stifling flow. Reflux is the cause of most cases of varicose veins, but can occur in deep veins as well.

    Compression – Vein anatomy differs from person to person. In some individuals, major veins are compressed by nearby anatomical structures. This increases pressure and obstructs blood flow.

    May-Thurner syndrome, also referred to as iliocaval venous compression syndrome or iliac vein compression syndrome, is one such condition in which a major artery presses a major vein against a bony structure in the groin area. In a similar way, obesity is thought to cause venous insufficiency by compressing major veins in the abdominal region.

    Obstruction – Because veins are low-flow, low-pressure vessels, they are susceptible to the formation of blood clots (thrombus) that obstruct flow. Clots can develop in both superficial and deep veins (deep vein thrombosis). Clots are often more serious in deep veins, especially when they form above the knee. If left untreated, clots in the veins harden into permanent obstructions, causing blood flow challenges throughout the veins.

    Post Thrombotic Syndrome – In the last decade or so, vascular specialists have found that venous insufficiency can persist even after the successful treatment of deep vein thrombosis. The presence of thrombus is thought to instigate a chronic inflammatory response that compromises the integrity of the veins over time.

    Symptoms of Venous Leg Ulcers

    Patient with venous ulcer and skin changes

    Leg Ulcers

    The lower leg undergoes major changes when venous insufficiency gets serious:

    • Ulcer – usually forms between the mid-calf and the ankle bone
    • Skin color changes – red-brown coloration or whitening of the leg can occur
    • Eczema – parts of the skin become red and itchy
    • Lipodermatosclerosis – the skin becomes tough and inflexible
    Patient with swelling caused by venous ulcer

    Leg Swelling

    Venous insufficiency causes blood to pool in the veins and leak into surrounding tissues, causing:

    • Edema – the leg becomes swollen with fluid
    • Varicose veins – swollen, bulging veins coursing along the surface of the leg
    • Heaviness – swelling can make the legs feel heavy
    • Fatigue, especially when active
    Patient with swelling caused by venous ulcer

    Leg Pain

    Venous insufficiency can cause a variety of pain patterns:

    • Leg cramps, especially at night
    • Claudication – thigh / leg pain and tightness when exercising
    • Aching, soreness, restless legs, or burning throughout the leg
    • Venous ulcer pain

    Venous Ulcer Risk Factors

    • Age  |   the older you get, the more likely you are to develop venous insufficiency
    • Gender  |   women are more likely than men to be diagnosed with venous insufficiency
    • Lifestyle or Occupation  |  extended periods of sitting, standing, or low mobility are thought to contribute to venous insufficiency
    • Obesity  |   vein compression in the abdomen may increase your risk of venous insufficiency
    • Family History  |   venous insufficiency may run in your family
    • Smoking  |   smoking has been shown to increase the risk of venous insufficiency

    Venous Ulcer Diagnosis

    A simple ultrasound exam is the first step to verify if you’re living with venous insufficiency. More advanced imaging techniques, such as venogram and intravascular ultrasound, may be necessary to assess more complex vein pathologies.

    ​IVC is a fully staffed medical imaging and treatment center that can help you confirm if you’re living with venous insufficiency. Give us a call to book your consultation!

    Dr. Aaron Fritts performing ultrasound exam on patient with venous ulcer

    Venous Ulcer Diagnosis in Dallas, TX

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    Venous Ulcer Treatment

    The root cause of a venous ulcer is severely insufficient blood flow in the veins of the leg. For this reason, venous ulcers are often referred to as ‘venous stasis ulcers,’ and treatment strategies are focused on improving blood flow throughout the venous system. In many cases, both superficial and deep vein problems must be addressed to fully heal the leg.

    When you see a Vascular Specialist, the goal of venous ulcer treatment is to ‘close down’ superficial vein disease, and to ‘open up’ deep vein disease. The idea here is to improve blood flow through the deep veins and to improve circulation in the superficial veins by re-routing blood flow through healthy veins nearby. Although these two treatments require different tools and very different approaches, they can both be performed by a Vascular Specialist using image-guided, minimally invasive techniques.

    Superficial Vein Closure

    Superficial vein closure is the gold standard to treat varicose veins that are contributing to venous ulceration. The phrase ‘superficial vein closure’ describes a variety of minimally invasive treatments that are used to close down varicose veins. This can be done by applying thermal energy, a specially formulated chemical irritant, or glue to the inside of the vein. Regardless of which treatment is used, this is a catheter-based, outpatient procedure that is performed through a single tiny puncture in the leg.

    Deep Vein Revascularization

    Deep vein revascularization is an image-guided procedure in which blood flow obstructions in the deep veins are opened up to improve blood flow and circulation. Flow obstructions can be caused by venous reflux, extrinsic compression, a blood clot, or chronic occlusion. A few different techniques are used by a Vascular Specialist to address these unique pathologies:

    Angioplasty  |  a balloon device is positioned along the length of the obstructed vein and inflated, forcing the obstruction to open

    Stenting  |  a tubular support device made out of a special metal or polymer is placed along the length of the deep vein obstruction and left in the vein to help it stay open after the procedure.

    Thrombectomy  |  a mechanical device is used to remove clot or chronic occlusion from a deep vein.

    Advantages of Minimally Invasive Venous Ulcer Treatment

    Diagram comparing healthy veins with vein reflux and vein obstruction causing venous ulcers

    Venous Ulcer Treatment: superficial vein reflux is treated with vein closure, and obstructed or compressed deep veins are treated with deep vein revascularization to restore healthy circulation.

    Minimally Invasive

    Superficial vein closure and deep vein revascularization are performed through a single puncture in the leg. Unlike major surgery, there’s no cutting, which means minimal trauma and faster recovery time.

    Image-Guided

    Treatment is performed under the guidance of imaging. This allows your doctor to safely provide therapy directly to the veins that need it with minimal risk of side effects.

    Venous Ulcer Treatment

    A skilled Vascular Specialist can successfully treat superficial and deep vein pathologies, providing your legs with the best opportunity to heal.
    Heal legs from venous ulcer icon

    Heal Your Legs

    Treatment restores healthy blood flow throughout the veins of the leg, allowing venous ulcers to heal.

    Reduce venous ulcer swelling icon

    Reduce Swelling

    Restoring healthy circulation takes the fluid off of your leg, so you can get back on your feet.

    Venous ulcer pain relief icon

    Pain Relief

    Treatment can help relieve cramps, claudication, and soreness in the leg caused by insufficient blood flow.

    Compare Venous Ulcer Treatment Options

    Compression Stockings

    Compression stockings are usually prescribed by general practitioners as a conservative, first-line therapy for venous insufficiency. They can help relieve symptoms by improving blood flow through the veins. However, this improvement in blood flow does not address the underlying pathologies involved in venous insufficiency, so continuous long-term use is required for stockings to be effective. Many patients have trouble staying compliant with their stocking prescription, which can render them ineffective.

    Wound Care

    Wound care consists of self-care techniques, special dressings / bandages, and lifestyle adjustments that keep the venous ulcer clean and promote healing of the skin. While wound care does not address the underlying vein problems that cause venous ulcers, wound care is an essential part of healing and should be continued when other treatments are pursued.

    Vein Stripping Surgery

    ​Vein stripping is a more invasive surgical alternative to superficial vein closure. This procedure is used to remove a superficial vein by threading a wire device through it and ripping the vein out. Vein stripping typically requires a major incisions at each end of the vein to access it and prep it for removal.

    Deep Vein Bypass Surgery

    Surgical bypass may be an appropriate treatment option in the case of a serious deep vein obstruction. Bypass surgery works by connecting a new vessel (a graft) from where sufficient flow is present to a section of the leg where it is absent. The new vessel may be a prosthetic or a major blood vessel from the patient or a donor.
    Minimally invasive venous ulcer treatment

    Superficial vein closure and deep vein revascularization do not require any major incisions. These procedures are done by an Interventional & Vascular Specialist using small tubes and wires.

    Treatment Options Summary

    Compression Stockings

    Usually prescribed as a first-line therapy for venous insufficiency; stockings can help improve venous ulcer symptoms but require continuous use to be effective.

    Wound Care

    Prescribed to keep ulcers clean and promote healing of the skin; wound care complements other treatments and should be continued to maximize healing.

    Vein Closure Treatment

    Minimally invasive procedure; recommended treatment for symptomatic superficial varicose veins contributing to venous ulcers.

    Deep Vein Revascularization

    Minimally invasive procedure; used to address deep vein pathologies, including venous reflux, extrinsic compression, blood clot, or chronic occlusion.

    Vein Stripping Surgery

    More invasive surgical alternative to superficial vein closure; vein stripping has been shown to require longer recovery time and has a higher risk of procedural complications than superficial vein closure.

    Bypass Surgery

    Major surgery; may be recommended when deep vein revascularization is not possible and/or certain veins are affected.

    Venous Ulcer Treatment in Dallas, TX

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    References
    [1] Eberhardt (2014). Contemporary Views in Cardiovascular Medicine: Chronic Venous Insufficiency. Circulation. 2014;130:333-346.
    [2] Meissner (2005). Lower Extremity Venous Anatomy. Seminars in Interventional Radiology. 2005;22(3):147-156.
    [3] Cesarone (2002). ‘Real’ epidemiology of varicose veins and chronic venous diseases: the San Valentino Vascular Screening Project. Angiology 2002; 53: 119–130.
    [4] Meissner (2016). What is effective care for varicose veins? Phlebology, 31(1_suppl), 80–87.
    [5] Gohel (2018). A Randomized Trial of Early Endovenous Ablation in Venous Ulceration. New England Journal of Medicine, 378(22), 2105–2114.
    [6] Kankam (2017). A summation analysis of compliance and complications of compression hosiery for patients with chronic venous disease or post-thrombotic syndrome. European Journal of Vascular and Endovascular Surgery, 55:406-416.
    [7] Lohr (2010). Radiofrequency Ablation: Evolution of a Treatment. Seminars in Vascular Surgery, 23(2), 90–100.​

    Medical Disclaimer
    The Materials available on ivcmd.com are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients.

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    12840 Hillcrest Rd Unit E104
    Dallas, TX 75230

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    Interventional & Vascular Care (IVC) provides minimally invasive image-guided procedures (MIIPs) to patients in the Dallas metroplex. Specializing in peripheral artery disease, venous insufficiency, uterine fibroids, and other conditions.

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