Lower extremity venous disease (LEVD) covers several dysfunctional disorders of the venous system, including the superficial veins, deep veins, and perforating veins. Damage or abnormalities in any part of the venous system can increase sustained pressure within the system. Symptoms of LEVD can include:
- Aching and heaviness
- Shallow wound(s) with irregular edges
- High exudate (drainage)
- Edema (swelling of the legs)
- Pain and swelling often relieved by leg elevation
- Hemosiderin staining (brownish discoloration of lower legs)
Treatment for LEVD can include exams to evaluate the blood flow in your legs (Ankle Brachial Index, or ABI), topical wound care, and compression therapy. Learn more about the ABI exam and compression therapy.
At the St. Charles Outpatient clinics, treatment for LEVD often begins with a non-invasive exam called an Ankle Brachial Index (ABI). ABI is an easy test to check the blood flow to your legs and feet. It can be done in 30 minutes by your wound care clinician.
On the day of your ABI appointment, we will have you lay as flat as possible for 10 minutes. Then your wound care clinician will check the blood pressure in your arms and legs using a manual blood pressure cuff and Doppler, or with an automatic ABI machine. This will feel the same as checking your blood pressure at the doctor’s office except you will be able to hear the sounds (the Doppler is louder than the stethoscope) and we use a gel on your skin where we place the Doppler. We compare the numbers for six different arteries to determine your ABI. This means we will check your blood pressure six times in different places on your arms and legs.
We will share the final results with you and your doctor so together we can better guide your care. The ABI will be used to determine the safe amount of compression to help your swelling and wound healing. If you have abnormal results, we will refer you for further testing with a vascular surgeon.
An ABI >1.3 indicates calcified arteries and patient should be referred to vascular surgeon for further assessment
An ABI of 0.9-1.3 indicates the patient can probably tolerate full compression (30-40mmHg)
An ABI of 0.5-0.8 indicates lower extremity arterial disease (LEAD); light compression is recommended (20-30mmHg)
An ABI < 0.5 is indicative of severe ischemia and should be emergently referred to a vascular surgeon to avoid loss of limb
(Link to Compression Therapy)
The use of compression to treat LEVD is the gold standard of treatment. Compression assists with improving venous return, reducing edema, reducing the diameter of vessels, and supporting the calf muscle pump. In addition, compression improves healing rates of venous leg ulcers. Options for compression that will be explored with your wound care clinician include multi-layer compression systems, compression socks, and adjustable wraps with Velcro straps. The table below shows different classifications of compression, and the indications for use.
