Venous ulcer treatment has shifted considerably over the past two decades, moving from wound care alone toward strategies that also address the underlying reflux driving the skin breakdown. A venous leg ulcer, classified as CEAP stage C6, develops when long-standing high pressure in the superficial or deep venous system damages the skin, most often near the ankle. While compression therapy remains the foundation of care, evidence has increasingly supported treating the incompetent vein feeding the ulcer alongside standard wound management.
What Causes a Venous Leg Ulcer to Form?
Venous ulcers typically form after years of chronic venous insufficiency, in which faulty valves allow blood to pool and pressure to build in the lower leg veins. This sustained pressure, called venous hypertension, damages the microcirculation of the skin and subcutaneous tissue, eventually causing the skin to break down, usually above the medial malleolus. Risk factors commonly cited include prior deep vein thrombosis, obesity, prolonged standing occupations, and a family history of varicose veins. Unlike arterial ulcers, venous ulcers are generally described as shallow, irregularly shaped, and associated with surrounding skin changes such as hemosiderin staining and induration.
How Does Treating Reflux Support Ulcer Healing?
When an incompetent superficial vein, most often the great saphenous vein, is identified as a significant contributor to the ulcer's venous hypertension, closing that vein is often considered alongside compression. Landmark clinical research in wound care has reported that early ablation of superficial reflux, performed once the ulcer is open rather than delayed until after healing, is associated with faster healing times and fewer ulcer recurrences compared to compression therapy alone. Endovenous techniques, including laser ablation and radiofrequency ablation, are commonly used for this purpose because they can be performed under local or tumescent anesthesia in an outpatient setting, which is an important consideration for patients who may have limited mobility or other comorbidities.
Is Ablation Used Instead of Compression or Alongside It?
Ablation is not typically used as a replacement for compression therapy in venous ulcer treatment; rather, it is used as an adjunct. Compression bandaging or stockings remain central to reducing edema and supporting venous return throughout the healing process, and most treatment pathways continue compression before, during, and after any endovenous procedure. A qualified physician determines suitability for ablation based on duplex ultrasound findings, ulcer characteristics, and the patient's overall vascular status, including whether deep venous obstruction or arterial disease is also present.
What Role Does INVAMED's LaserBLOCK System Play?
For patients whose venous ulcer is linked to great saphenous or small saphenous vein reflux, thermal ablation systems such as the LaserBLOCK Varicose Vein Laser System are used to seal the incompetent vein under ultrasound guidance. The system is designed for endovenous laser therapy using various wavelengths and fiber configurations intended to distribute energy evenly along the vein wall. As with any ablation approach in the setting of an open ulcer, a physician evaluates wound status, infection risk, and vein anatomy before proceeding. More background on ablation-based approaches for venous disease is available on the varicose vein products page.
Is ablation safe to perform while an ulcer is still open?
Many published wound-care pathways describe treating reflux early, even while the ulcer remains open, though the decision depends on infection control, ulcer size, and overall patient health. Availability and indications vary by country, and a physician reviews the Instructions for Use and individual case details before proceeding.
Device availability and regulatory status vary by country. Please contact INVAMED or your authorized local distributor for current regulatory information applicable to your region.