JCCVS
Journal of Cardiology & Cardiovascular Surgery

Journal of Cardiology & Cardiovascular Surgery scientific, open-access, double-blind peer-reviewed journal covering a wide spectrum of topics in cardiology and cardiovascular surgery.

eISSN: 2980-1397
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Management of venous ulcers in chronic venous insufficiency: a comprehensive review of etiopathogenesis, biomechanical failure, and evidence-based therapeutic strategies
Abstract
Chronic venous insufficiency (CVI)-induced venous leg ulcers (VLUs) represent the most advanced stage of venous disease (CEAP C6) and pose a significant clinical and socioeconomic burden. This review aims to evaluate the biomechanical failure of the calf muscle pump, the impact of environmental and systemic factors, and current evidence-based interventional strategies in VLU management. The pathophysiology of VLU is driven by ambulatory venous hypertension. Factors such as prolonged heat exposure, static occupational loading, and systemic comorbidities like diabetes mellitus and smoking further impair the healing process by promoting chronic inflammation and biofilm formation. A comprehensive literature review was conducted, focusing on key clinical trials including EVRA, ESCHAR, and RECOVERY, to analyze the efficacy of endovenous thermal ablations (EVLA, RFA), foam sclerotherapy, and advanced wound care modalities. Evidence confirms that early interventional treatment (ablation within 2 weeks of ulcer presentation) significantly accelerates healing rates. Biomechanical support via graduated compression therapy remains the gold standard for preventing recurrence. Furthermore, the role of “cell-friendly” wound cleansing using clean water, rather than cytotoxic antiseptics, is emphasized for maintaining the integrity of fibroblasts and keratinocytes. Successful VLU management requires a multidisciplinary approach focusing on three pillars: reducing venous pressure through early intervention and compression, activating the calf muscle pump through mobilization, and controlling systemic risk factors.

Keywords : Chronic venous insufficiency, venous leg ulcer, calf muscle pump, endovenous laser ablation, radiofrequency ablation, biofilm

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Article available in :
Volume 4, Issue 3, 2026
Page : 62-65
https://doi.org/10.51271/JCCVS-0080
Article Information
Received : 14 Kas 2025
Accepted : 19 Ara 2025
Published : 30 Eyl 2026
Corresponding Author :

Mehmet Kabalcı: Department of Cardiovascular Surgery, Faculty of Medicine, Kırıkkale University, Kırıkkale, Turkiye

[email protected]
Citation : Kabalcı M. Management of venous ulcers in chronic venous insufficiency: a comprehensive review of etiopathogenesis, biomechanical failure, and evidence-based therapeutic strategies. J Cardiol Cardiovasc Surg. 2026;4(3):62-65. doi:10.51271/JCCVS-0080

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