Chronic Venous Insufficiency and Venous Hypertension: Understanding the Link to Leg Ulcers

mdavis107
Nov 13, 2020
4 min read

Updated: May 7

What Is Chronic Venous Insufficiency?

Chronic venous insufficiency (CVI) occurs when leg veins can’t effectively return blood to the heart. This results in blood pooling in the lower extremities, increasing venous pressure and damaging vein valves. Over time, this backward flow impairs circulation and can lead to swelling, tissue damage, and chronic non-healing wounds.

How Venous Hypertension Impacts Circulation

Venous hypertension is a condition in which pressure inside the leg veins remains abnormally high over time—often due to CVI or past episodes of deep vein thrombosis (DVT). Elevated pressure stretches and weakens vein walls and valves, which worsens the pooling of blood. This chronic backflow can ultimately lead to varicose veins and venous leg ulcers.

Edema and Tissue Damage Explained

As venous pressure rises, capillary pressure also increases. This slows down circulation and restricts oxygen and nutrient delivery to tissues while reducing the removal of waste products like carbon dioxide. Fluid begins to leak from capillaries into surrounding tissues, causing edema.

Swelling increases the distance that nutrients must travel to reach cells and impairs tissue oxygenation. These changes reduce cellular viability and delay wound healing—making tissues more vulnerable to breakdown.

The Role of Fibrin Cuffs in Leg Ulcers

Prolonged venous hypertension causes capillaries to dilate and the gaps between endothelial cells to widen. This allows plasma proteins like fibrinogen to escape into the tissue. Once outside the bloodstream, fibrinogen converts into fibrin, forming sticky strands that wrap around the capillaries and create what researchers call a “fibrin cuff.”

Fibrin cuffs further block the exchange of oxygen and nutrients, starving surrounding tissues and contributing to ulcer formation. This mechanism is one reason why chronic venous insufficiency is such a major driver of venous leg ulcers.

Types of Leg Ulcers and Their Causes

Leg ulcers are categorized based on their underlying cause:

Venous ulcers are the most common and are directly linked to chronic venous hypertension and CVI.
Arterial ulcers result from poor blood supply due to peripheral arterial disease.
Diabetic ulcers occur in individuals with diabetes and may stem from ischemia, neuropathy, or both.
Rheumatic ulcers can develop in individuals with autoimmune conditions like rheumatoid vasculitis.

Signs of Venous Ulcers: How to Identify Them

Venous ulcers usually form around the inner ankle and are described as shallow, irregularly shaped, and moist due to fluid leakage. Pain is common, and edema is typically present in the affected limb.

A classic sign of long-standing venous disease is brown skin discoloration, caused by hemosiderin, a breakdown product of hemoglobin from red blood cells that have leaked into the tissues.

Accurate identification is essential because treatment strategies differ based on the ulcer’s cause.

Diagnosing Ulcer Etiology with ABI Testing

The Ankle Brachial Index (ABI) is a critical tool in evaluating ulcer etiology. It compares blood pressure in the ankle and arm to assess arterial blood flow. An ABI value greater than 0.9 generally indicates normal arterial supply, suggesting a venous origin for the ulcer.

If arterial insufficiency is suspected (ABI < 0.9), compression therapy must be used with caution—or not at all—depending on severity. In some cases, patients may present with mixed etiology ulcers, showing both venous and arterial features.

Compression Therapy: A Critical Treatment Strategy

Compression therapy is the gold standard for treating venous ulcers. It reduces venous pressure, improves blood return, and supports the calf pump mechanism. Compression not only promotes healing but also reduces recurrence rates significantly when maintained over time.

Choosing the Right Type of Compression

Compression therapy comes in two main forms:

Elastic compression: Provides consistent pressure and is ideal for non-ambulatory patients or those with limited ankle mobility.
Inelastic compression (e.g., Unna boots): Offers intermittent pressure during movement and works best for ambulatory patients with at least 45° of ankle motion to fully engage the calf muscle pump.

⚠️ Important: Avoid tubular sleeves for ulcer treatment. These can reverse the intended pressure gradient by applying more pressure at the knee than the ankle, which can hinder circulation.

Final Thoughts: Improving Outcomes for Venous Ulcers

Chronic venous insufficiency and venous hypertension are leading contributors to leg ulcers, edema, and poor circulation. Early diagnosis, accurate ulcer classification, and appropriate compression therapy are vital to restoring tissue health and preventing recurrence.

If you or a loved one is experiencing signs of chronic leg swelling, skin discoloration, or non-healing wounds, consult a healthcare provider for a full vascular assessment and customized care plan.

Shared Health Services partners with hospitals and physician practices to support the development of successful wound care programs—equipping care teams with tools, resources, and clinical expertise to improve outcomes for patients with venous ulcers and other chronic wounds.