Venous Ulcers

The high incidence and prevalence of chronic venous disease has a considerable impact on healthcare. Advanced venous disease, characterized by edema, skin changes and leg ulceration, impacts over 2.5 million people in the United States annually.

The AVF gathered a group of international experts at its 2009 Pacific Vascular Symposium VI to summarize current principles in venous ulcer diagnosis and management, which led to a major initiative: to reduce venous ulcers by 50 percent in ten years.

Out of this came a series of recommendations:

  • Creating standardized diagnostic evaluations using venous duplex scanning and arterial evaluation (ABI) with accredited (ICAVL) diagnostic vascular laboratories.
  • Educating primary and specialty physicians about chronic venous disease as a lifelong degenerative condition, and the importance of adequate testing, compression treatment, correction of venous reflux obstructions, and surveillance programs to track venous ulcer patients.
  • Building a robust public awareness campaign so patients contact their healthcare provider when experiencing the following: leg heaviness or cramping, leg pain after ambulating that is relieved with rest and elevation, and history of deep venous thrombosis.
  • Encouraging CME accreditation for physicians at various levels, and incorporating questions about chronic venous disease on board certification examinations for primary care physicians.
  • Collaborating with wound care organizations, venous-schooled practitioners, Health Maintenance Organizations, Veterans Administration and Medicare.
  • Ramping up thrombolysis/thrombus removal and stent registries to define the population best served by this therapy.


  1. 50% compliance using compression therapy in venous ulcer care in 2 years, and 75% in 5 years
  2. 80% compliance using chronic duplex scan in wound clinics in 3 years, and 100% in 5 years.
  3. 50% compliance by wound care and venous specialty clinics with interventional treatment to eliminate superficial venous reflux and other selective sources of focal axial reflux in 3 years, and 80% compliance in 5 years.
  4. Awareness programs for the public and educational programs for the healthcare profession within 1 year.
  5. 50% recognition by primary care medical societies that chronic venous disease is a lifelong progressive degenerative disorder in 5 years.