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Treatment Options for Non-healing, Lower-extremity Ulcers

Patients suffering from non-healing ulcers on the legs are often treated for months—even years—using topical medications and by the removal of dead tissue. This prolongs pain, does not address the cause of the ulcerations and severely impacts quality of life.

Non-healing ulcers are often the result of end-stage venous disease, affecting up to 3% of the adult population. In fact, the majority of lower extremity ulcers are the result of venous disease (70-80%) and less likely due to arterial disease (10-20%). Because these type of wounds are venous-related, endovenous thermal ablation is a successful treatment option that replaced venous stripping as a primary treatment for venous disease around 15 years ago.

At EPIC Imaging’s outpatient center, Dr. Costantino performs endovenous thermal ablation using radiofrequency or laser to create intense local heat in the varicose vein. Heat is directed through a catheter into a tiny access point in the lower leg to seal the problematic refluxing veins.


  • Minimal bleeding and bruising, less pain and faster return to normal activities with similar cosmetic results compared to vein ligation and stripping
  • Typically only one treatment is required; in patients with complex disease, several veins may be targeted
  • Patient wears compression stockings following treatment to aid in healing

DENNIS W., AGE 70

MEDICAL CONDITION: Non-healing ulcers on both sides of left leg for five months.

TREATMENT: Three total treatments in September 2016, to include left Great Saphenous Vein (GSV) ablation, left Small Saphenous Vein (SSV) ablation and
ultrasound-guided sclerotherapy.

DETAILS: Dennis is an active 70 year old with several months of medial malleolar ulcers, being treated with very painful weekly debridements. When he came to us we immediately obtained an ultrasound which demonstrated severe reflux, with large refluxing vessels supplying the ulcers. Whether there is moderate or severe disease, the procedure and associated risks are the same.

We treated Dennis in our office with two ablations, which take about 20 minutes each. There is no need for hospitals or surgery centers, which add unnecessary costs. Ablation is done right in our office with either no sedation, or oral sedation depending on the patient’s level of anxiety.

After two ablations, there were multiple enlarged varicosities with near stasis of venous flow, therefore we performed ultrasound guided-sclerotherapy. Using
ultrasound guidance a small butterfly needle is inserted into the large branching varicosities and a foam solution is injected to destroy the wall of the vein (sclerosis) which results in vein collapse.

Following treatment and compression stocking use, Dennis’ ulcers healed quickly. Even better, he needed no additional painful debridements.

GASPAR C., AGE 44

MEDICAL CONDITION: Non-healing ulcers on both legs for two years. 

TREATMENT: Four treatments in December 2016, to include left GSV ablation, right GSV ablation, left SSV ablation and left ultrasound-guided sclerotherapy.

DETAILS: Gaspar presented with two years of ulcers in his bilateral medial mallelor region. This is pathognomonic for venous stasis and always should be recognized as such. Gaspar has a strong family history with all seven of his brothers and sisters developing ulcers at a young age. These ulcers and associated symptoms of venous congestion with leg heaviness, burning, achiness and pain, result in the inability to stand, walk, or work. Patients are miserable, as was Gaspar. We obtained an ultrasound which demonstrated severe disease in the four main veins in the superficial system. This was expected based on physical exam. In one setting we ablated all four vessels, sealing off all of the veins which allowed blood to pool in the lower extremities. Blood is redirected into the deeper venous system where it can be pumped back towards the heart. Within weeks, Gaspar’s ulcers—from which he suffered for two years—were healed. There is no telling how long he would have had active ulceration had he not been treated, whether his ulceration would have worsened to the point of amputation given his young age.