Professor Mark Whiteley: Current thinking in lower limb management

I was asked to present about the trial of the venous system, and one thing that's been misunderstood for a very long time in venous ulcers is approximately 50% are now curable if we understand the venous system properly. It's not just the varicose veins and the hidden varicose veins that can now be treated, but it's also in the old days when we thought blocked deep veins couldn't be treated and had to be compressed, we now know we can open them with stents. So it's trying to understand the and trying to help people understand you mustn't just look at leg ulcers from the outside and assess them and feel the pulse. Nowadays we have to do a venous duplex ultrasound scan so we have to understand the venous pumping and those patients that we can actually improve that we can actually cure their ulcer. So it's the difference between healing ulcers and curing ulcers. So the NICE guidelines have shown the cost advantage of treating varicose veins and venous leg ulcers and what's this actually said if you look up NICE guidelines CG168, which actually is the NICE guidelines for varicose veins, one of the indications to be referred for a venous duplex ultrasound scan and treatment of the veins is a healed leg ulcer or an open leg ulcer provided it's been there for two weeks or more. So anyone with a leg ulcer more than two weeks must be referred for a venous duplex ultrasound scan. The problem with it is of course is what happens is a lot of vascular surgeons aren't interested in leg ulcers and because we don't have phlebologists, a lot of the nurses who would like to refer the patients don't have any way to refer them to. Plus the other guidelines, the nursing guidelines quite often don't have anything about sending duplex reports or even look at the venous system at all. So the moment we need to amalgamate all the guidelines and we have to have proper support for the people treating leg osses so that if there is someone who's curable they can be scanned properly and can have a cure.