# Anterior leg ulcer secondary to great saphenous vein incompetency: A case report

## TL;DR

A 54-year-old man with a long-standing leg ulcer was successfully treated after identifying and addressing a faulty vein using ultrasound and surgery.

## Contribution

The case highlights the importance of detailed ultrasound mapping for effective treatment of venous ulcers.

## Key findings

- Doppler ultrasound identified severe reflux in the greater saphenous vein.
- Surgical intervention after compression therapy led to complete ulcer healing.
- Accurate reflux pathway mapping is critical for preventing ulcer recurrence.

## Abstract

Chronic venous insufficiency (CVI) is a common medical problem causing complications like limb edema, pain, and ulceration. Effective management requires accurate diagnosis and targeted treatment, with Doppler ultrasonography playing a crucial role in assessing reflux pathophysiology and guiding treatment decisions.

A 54-year-old man with a chronic ulcer in his left leg was diagnosed with stasis ulcer. Despite multiple treatments, his ulcer remained active for about 2 years. DUS revealed severe reflux along the greater saphenous vein to a point below the knee. He was scheduled for surgery after a 2-month course of compression therapy. The wound healed after 2 months, and the 6 months' follow-up was unremarkable.

Venous ulcers are chronic wounds caused by venous insufficiency. The most common location for ulcers is the peri malleolar region. Doppler ultrasonography is the primary diagnostic tool for managing chronic venous insufficiency, and comprehensive mapping of the entire reflux pathway is essential for optimizing patient outcomes and minimizing the risk of recurrence. Compression therapy is the main treatment for chronic venous insufficiency, and removing the reflux pathway is the most appropriate intervention to enhance wound healing and prevent ulcer recurrence. Less invasive interventions, such as thermal and chemical ablation, and stripping, have become more popular in recent decades.

Although most of ulcers secondary to greater and lesser saphenous vein insufficiency occur in distinct locations, but detailed ultrasonographic mapping of the reflux pathway is critical for prompt management of the venous insufficiency and prevent recurrences.

•In United States, 4 % of adults have venous ulcers.•Most of ulcers secondary to GSV incompetency occur around medial malleolus.•Accurate description of reflux pathway is crucial for proper management of venous ulcers.•Doppler ultrasound is the most useful modality for delineation of the reflux pathway.•Elimination of reflux is the key factor to treat venous ulcers and prevent recurrences.

In United States, 4 % of adults have venous ulcers.

Most of ulcers secondary to GSV incompetency occur around medial malleolus.

Accurate description of reflux pathway is crucial for proper management of venous ulcers.

Doppler ultrasound is the most useful modality for delineation of the reflux pathway.

Elimination of reflux is the key factor to treat venous ulcers and prevent recurrences.