This chapter discusses the venous ulcer and arterial insufficiency. Venous stasis ulceration (VSU) results from chronic venous disease. VSU in combination with peripheral arterial disease (PAD) represents a morbid condition requiring keen diagnostic and treatment skills of the health care provider. Although somewhat conflicting in its prevalence, the overall ubiquity of leg ulcers requires a methodical approach to identify all factors leading to lack of healing and recalcitrance. Patients with VSU should undergo vascular laboratory testing to confirm diagnosis of CVD and appropriately ascribe the cause of pathophysiologic dysfunction to reflux, obstruction, or both etiologies. Each patient's treatment plan must be tailored to the distribution of arterial and venous insufficiency that exists. Therefore, the health care team should be equipped to offer the full spectrum of treatment techniques in arterial revascularization, venous insufficiency, and venous obstruction. Primary recommendation of amputation should not be considered a failure in selected patients. Freedom from pain, infection, and wounds is often the quickest way to alleviate prolonged suffering.
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