Mayo Clinic Talks Vascular Medicine Series: Vascular Wound Treatments
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Sep 23, 2025 Dr. Matthew (Mark) Melin, a vascular medicine specialist, dives into the complexities of vascular wounds. He explains the critical differences between venous and arterial ulcers and the importance of accurate diagnoses. The conversation highlights effective treatments and the necessity of timely referrals to specialists for severe cases. Preventative measures, such as addressing diabetic neuropathy and promoting smoking cessation, are discussed alongside emerging therapies like hyperbaric oxygen treatment and platelet-derived exosome therapy, ensuring a holistic approach to wound care.
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Venous Ulcer Pathophysiology
- Venous leg ulcers usually result from venous valve failure causing venous hypertension that floods tissues and overwhelms lymphatics.
- This process then compromises microvascular (8 micron) arterial flow and leads to ulceration.
Use Standing Duplex For Venous Insufficiency
- Diagnose venous insufficiency with a standing duplex ultrasound rather than a standard DVT study done supine.
- Refer to venous specialists and wound clinics when venous reflux or varicosities are identified.
Always Check ABI Before Compression
- Obtain an ankle-brachial index on all lower-extremity ulcers to screen for mixed arterial disease before applying compression.
- Treat significant arterial disease first because compression in mixed disease can worsen ischemia.