Images of Note: Volume-Based Expertise in Complex Venous Wound Care

Cleveland Clinic is home to the largest and busiest noninvasive vascular laboratory in the U.S., with more than 2,220 clinical vascular imaging studies performed monthly.

These studies include duplex venous ultrasonography for assessing lower extremity venous obstruction, venous insufficiency, varicose veins or venous valvular reflux disease, all of which can lead to delayed venous wound healing (Figure 1).

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Figure 1. (Top) A representative short-axis grayscale ultrasound image showing venous insufficiency of the great saphenous vein (white arrow). Note the dilated vein, which is considered a varicose vein. (Bottom) Example of a longitudinal grayscale image (orange arrow) of the same varicose vein showing valvular incompetency as a function of reversal of venous flow (blue star). This phenomenon often leads to nonhealing leg venous ulcers.

Besides serial debridement and wound bed preparation, our vascular medicine physicians use various wound dressing materials to absorb wound drainage and mobilize cellular matrix to promote wound healing (Figure 2). Additionally, multilayer compression garments are commonly used for patients with venous wounds to reduce leg swelling and venous hypertension.

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Figure 2. Section of Vascular Medicine staff physician Geoffrey Ouma, DO, tends to a patient’s lower extremity venous wound.

Cleveland Clinic’s vascular medicine specialists also collaborate with their vascular interventionalist colleagues to help restore arterial flow to the leg in cases of arterial obstruction and to employ endovenous laser ablation to treat varicose veins associated with venous leg wounds.