Chronic Venous Insufficiency and Leg Ulcers in Singapore

Chronic venous insufficiency (CVI) means that veins in the legs do not return blood effectively towards the heart. Persistently raised pressure can cause swelling, aching and skin changes. In more advanced disease, the skin may break down into a venous leg ulcer. Treatment starts by identifying why the pressure is high and what else may be affecting the leg.

CVI is related to varicose veins and venous reflux, but the visible veins do not show the whole problem. Some people have troublesome swelling or skin damage without large bulging veins. Dr Andrew Choong’s video article explaining chronic venous insufficiency introduces the condition.

What causes chronic venous insufficiency?

Healthy vein valves and the calf muscles help move blood upwards against gravity. When valves leak, blood flows backwards: this is reflux. Narrowing or blockage in deeper veins can also obstruct drainage. Some people have both problems.

Valve problems may develop without a previous clot. In others, a past deep vein thrombosis (DVT) leaves scarring or damaged valves; persistent symptoms afterwards may be called post-thrombotic syndrome. Age, excess weight, pregnancy history and a family tendency to vein disease can be relevant. Reduced mobility can make the calf pump less effective.

Which symptoms and skin changes matter?

• Heavy, aching legs or ankle swelling, often more noticeable after prolonged standing.
• Itching, dry or inflamed skin, especially around the lower leg.
• Brown discolouration, thickened or hardened skin near the ankle.
• A wound that is slow to heal or repeatedly opens again.

These findings deserve assessment, but do not establish a diagnosis on their own. Swelling can also arise from medicines, lymphatic problems or other medical conditions. The article on different causes of leg swelling explains why it should not automatically be labelled water retention or venous disease.

How is the cause assessed?

The consultation reviews symptoms, previous clots or procedures, medicines, mobility and other illnesses. Examination considers the swelling, skin, wound and circulation. Bring previous scan reports and a record of treatments already tried.

Venous duplex ultrasound can assess reflux and obstruction and help identify which veins are responsible. Further imaging may be needed when a problem higher in the pelvis is suspected. An abnormal scan must fit the clinical picture before an intervention is recommended.

With a leg ulcer, arterial blood supply also needs assessment, often including ankle or toe-pressure measurements. Peripheral arterial disease can coexist with venous disease and change which treatment is safe. A wound cannot reliably be classified from a photograph alone.

What is a venous leg ulcer?

A venous ulcer is an open wound related to longstanding venous pressure, usually on the lower leg around the ankle. The surrounding skin may be swollen, discoloured or inflamed. Some wounds have several causes; diabetes, arterial disease, infection and pressure damage require their own consideration.

An ulcer that does not improve, looks unusual or repeatedly returns needs reassessment. Care should address its cause as well as the wound surface. The separate diabetic-foot and vascular wound guide explains the different issues affecting foot wounds.

What treatments can help?

Movement, skin care and symptom management

Suitable walking and ankle movement help the calf pump. Avoiding long periods of stillness, resting with the legs raised and weight management where appropriate may reduce symptoms. Skin care and treatment of eczema should follow individual advice; a cream cannot correct an underlying drainage problem.

How is compression chosen?

Compression stockings, wraps or bandages can reduce swelling and support venous-ulcer healing. The type, fit and pressure need to match the circulation, skin condition and ability to use the garment. A wound team may use a different system from stockings chosen for uncomplicated symptoms.

Do not start strong compression over an unexplained wound without assessment. Significant arterial disease can make it unsafe. Report new pain, numbness, coldness or colour change promptly rather than tolerating a poorly fitting or unsuitable device.

Dressings and infection treatment

Dressings manage moisture and protect the wound; regular review checks its progress. Antibiotics are used when clinical infection is present, not simply because an ulcer is open or a swab finds bacteria. Spreading redness, increasing warmth or pain, or fever needs prompt medical advice.

When is a vein procedure considered?

If suitable superficial reflux contributes to symptoms or an ulcer, options can include radiofrequency or laser ablation, vein glue or sclerotherapy. Treating relevant reflux early can help an active venous ulcer heal alongside compression and wound care; it is not always necessary to wait until the ulcer closes.

Choice depends on anatomy, arterial supply, previous treatment and individual risks. Deep-vein obstruction requires a different assessment. Procedures carry risks such as pain, bruising, inflammation, skin staining, nerve injury and blood clots. Treatment cannot promise a healing date or eliminate recurrence.

Which changes need urgent help?

New one-sided swelling or pain, a rapidly worsening wound, spreading redness or fever needs urgent assessment. A suddenly cold, painful, numb or weak foot needs emergency care. Do not assume a new change is simply your usual CVI.

Call 995 in Singapore for sudden severe breathlessness, collapse, heavy bleeding or other life-threatening symptoms. Chest pain or breathlessness with a swollen leg may indicate pulmonary embolism. Do not wait for a routine appointment or online reply.

Common questions

Can chronic venous insufficiency be cured permanently?

Treatment can address specific reflux or obstruction and improve symptoms, but the tendency to venous disease may remain. Continued skin care, appropriate compression and follow-up can still matter after a successful procedure.

Does an ulcer need follow-up after it heals?

Yes. Review should address the underlying veins and a plan to reduce recurrence. Report a new skin break early. The compression and follow-up plan should remain practical enough to continue.

Discussing venous symptoms in Singapore

For a non-emergency assessment, contact Andrew Choong Vascular Surgery at Mount Elizabeth Novena Specialist Centre, #09-22, 38 Irrawaddy Road, Singapore 329563. Bring your medicines, scan reports and wound-care history. Together, these help clarify the cause and the next treatment decision.

Videos about leg swelling and venous reflux

Watch Dr Andrew Choong’s explanation of chronic venous insufficiency, then explore the vein and leg-swelling video collection for related discussions about vein valves, symptoms and ultrasound assessment.