Online Vein Self-Assessment


C6: Active Venous Ulcer

C6 – is the most severe category, means that an active open venous ulcer is seen on the skin

C6 ulcer photo c6 (2) ulcer leg

C6, the most severe category, means that an active open venous ulcer is seen on the skin.  The skin fails to heal spontaneously and is sustained by chronic venous disease

What is a venous skin ulcer? A skin opening (ulcer) that is caused by poor circulation (stasis) in venous blood flow.  Poor venous circulation is termed venous insufficiency and is often caused by backwards blood flow (venous reflux).  The ulcer is called a venous stasis ulcer. Early signs that a venous stasis ulcer may develop include a darkening of the skin in the area of the ankle. Gradually, the skin may become leathery or waxy in appearance. Without treatment of the venous disease, the skin may breakdown causing a skin opening.  Often spontaneous bleeding will occur.

Venous ulcers are the most severe external sign of an underlying vein problem known as venous insufficiency.  Venous insufficiency is more likely to be present in patients who have vein-related symptoms such as chronic pain and discomfort, leg heaviness, leg swelling, or leg cramping.

  • As veins begin the process of becoming abnormal, their walls begin to weaken and stretch out.
  • What causes this vein wall weakening to occur?  Recent research shows that it is a complicated process involving inflammation in the body that results in damage to the vein wall.   At this point, we don’t understand what triggers the inflammation, or how to prevent it.
  • As the vein stretches and becomes wider, the vein walls pull apart the one-way valves, allowing gravity to take over and pull extra blood down toward our feet (reflux).
  • Other causes for venous ulceration includes obstruction or blockage in the vein.  The blockage can be within the vein due to blood clots or the blockage can be outside of the vein (external) due to a compression.  External vein compression may be due to a syndrome called “May Thurner” or a compression may be due to a tumor or other abnormality.  Compression syndromes vary in severity. When blood drainage is impaired, venous pressure is present which may cause the vein to dilate and eventually create a skin problem, including ulceration.

Finding the Right Doctor

A crucial step in obtaining the best treatment and results is finding the right doctor. The American College of Phlebology (ACP) is the premier association for vein care specialists in the United States. With more than 2,000 physicians and allied health care professionals in the network, finding a doctor in your area has never been easier. Click the link below to visit the ACP’s find a physician page and locate a doctor near you.

Find a Physician

More Information:

Symptoms Detection Treatment  Risk Factors


Symptoms commonly described by patients suffering from venous disease include:

  • visual abnormalities
  • leg discomfort
  • pain
  • aching
  • throbbing

  • burning
  • heaviness
  • fatigue
  • swelling
  • intense itching

If you experience leg symptoms, seeking professional advice is suggested.


Vein disorders are not always visible; diagnostic techniques are important tools in determining the cause and severity of the problem. In addition to a physical examination, non-invasive diagnostic “duplex” ultrasound is often used.  Duplex ultrasound can accurate detect venous blood clots and abnormal blood flow.


  • The treatment of venous ulcers must begin with a comprehensive consultation with a vein specialist.
  • The goal of treatment is to heal the ulceration.
  • In addition, other symptoms are improved or eliminated with treatment.
  • Conservative treatment such as wearing compression stockings will be beneficial in healing the ulceration.
  • Regular exercise, such as walking is recommended.
  • Plant-based bioflavenoid supplements have anti-inflammatory properties and have been shown to have beneficial effects on vein disorders as well.
  • Natural supplements can be an important addition to your vein treatment, and supplements have been found to reduce symptoms such as aching, heaviness, and swelling in the legs.
  • Healing of the ulcer may include a combination of treatment options.  Restoration of sufficient circulation may be indicated.
  • Elimination of the venous cause of skin changes may include a combination of treatment options, depending on the diagnosis. Compression therapy is needed to reduce pressure in the vein.
  • Patients often require diagnostic ultrasound examinations of the leg.  Ultrasound often finds that the root cause of the skin changes actually lies deeper in the circulation.

Risk Factors

There are a number of reasons why venous ulcers occur. Physicians refer to these causes as risk factors. As people age, vein issues become more common. Small problems that started earlier often progress into larger ones

Other risk factors include:

Family History  Trauma  Medications  Pregnancy  Occupation  Other

Family History

  • If you have immediate family members who have vein problems, chances are that you may develop them as well.  Vein disorders are hereditary.
  • Inherited factors related to blood clots or clotting disorders are also important, as you could also have inherited the same clotting disorder.


  • Soft tissue injuries can often result in the onset of swelling due to damage of the venous or lymphatic drainage.
  • This can happen as a result of an impact injury, such as getting hit with a ball or another hard object.   Trauma can subsequently lead to thrombosis.  Varicose veins in that area of your leg may appear.
  • The damaged veins may not be evident for some time.
  • Post-surgical patients carry risks for blood clots, often due to inactivity or immobility.
  • Skin changes may be due to chronic fluid or swelling in the damaged area.


  • Female hormones such as estrogen and progesterone can increase risk factors for venous disease.
  • The most common medications to do this include oral contraceptives (birth control pills), hormone replacement therapy, and infertility drugs.


  • Progesterone levels remain very high during pregnancy.
  • Progesterone relaxes the muscle in the vein walls, allowing them to stretch.
  • The physiologic changes that a woman undergoes during pregnancy place her at risk for the development of spider and varicose veins, which worsen with age.


  • Standing or sitting for long periods of time can worsen venous ulcers.
  • Teachers, nurses, flight attendants, hairstylists, sales clerks, etc., are very prone to developing venous skin changes, including ulcerations as depicted in the photos above.
  • An underlying venous problem likely is present when ulcerations are evident.   The precise ulcer location and skin changes are highly suggestive of impaired venous circulation.  This can be mechanical or physiological.  Professional medical advice is recommended.

Other Medical History

  • The presence of skin ulcers, such as the changes depicted in photos above, is the most severe form of venous problems.   Other concomitant diseases, including heart disease, kidney disease, venous obstruction/blockage, or other medical problems may be associated with lower extremity skin changes.  Professional medical advice is highly recommended and necessary.
  • People often assume that weight is a risk factor in venous disease. While many patients find that they feel better when they maintain a healthy weight, the actual influence of weight on the development of ulceration is not clearly known.
  • A risk factor likely exists in patients who are grossly overweight.
  • Gait:  how we walk is critical to movement of the blood.  It is important to have the blood pumped through the veins by activating our calf muscles.  This can be facilitated by fully flexing the ankle, known as dorsiflexion.   Individuals with orthopedic impairment may be at greater risk of developing venous blood impairment.  Patients likely will develop venous symptoms and venous insufficiency.
  • Blood clots: often familial but a very important risk factor for venous disease.
  • Poor nutrition is often a factor to skin ulceration.