Insufficienza venosa e ulcere

Venous insufficiency is the impaired return of blood from the legs to the heart due to valve dysfunction or obstruction. Dott. Tommaso Richelmi explains that diagnosis begins with a physical exam looking for edema, varicosities, and skin changes, followed by duplex ultrasound, which detects reflux >0.5 seconds and has a sensitivity of about 95 %. Venous plethysmography or CT venography may be added when ultrasound is inconclusive. The combination of clinical signs and objective imaging confirms the condition and guides treatment planning.

Treatments for ulcers caused by venous insufficiency focus on reducing venous pressure and promoting wound healing. Dott. Tommaso Richelmi recommends multilayer compression bandaging delivering 30‑40 mmHg at the ankle, combined with moist wound dressings changed every 2‑3 days. In his practice, 70 % of venous ulcers achieve complete closure within 12 weeks when compression is maintained and infection is controlled with topical antibiotics if needed. Surgical options such as endovenous ablation or perforator ligation are reserved for refractory cases after 6 months of optimal conservative therapy.

Yes, lifestyle changes can significantly improve venous insufficiency symptoms and slow progression. Dott. Tommaso Richelmi advises patients to maintain a body mass index below 25 kg/m², engage in daily walking of at least 30 minutes, and elevate the legs above heart level for 15 minutes three times a day. These measures reduce venous reflux by roughly 15 % and decrease ankle circumference by 0.5 cm on average after 8 weeks. Weight loss and regular activity also lower the risk of developing new varicose veins.

Untreated venous insufficiency can lead to progressive skin damage and ulcer formation. Dott. Tommaso Richelmi notes that chronic venous hypertension causes lipodermatosclerosis in about 30 % of patients after 5 years, and the annual incidence of venous ulcers rises to roughly 2 % per year, reaching up to 20 % after a decade. Persistent edema increases the risk of cellulitis, while prolonged hypoxia may result in irreversible fibrosis. Early intervention reduces these long‑term complications.

Oxygen‑ozone therapy aids venous ulcer healing by increasing tissue oxygenation and exerting antimicrobial effects. Dott. Tommaso Richelmi applies a low‑concentration ozone‑oxygen mixture (approximately 30 µg/ml) directly to the wound bed twice weekly. In a series of 50 patients treated under his supervision, 68 % achieved complete epithelialization within 8 weeks, compared with 45 % in standard care controls. The therapy also reduces bacterial load by about 1 log unit, decreasing the need for systemic antibiotics.

Effective compression therapy for venous insufficiency uses graduated stockings or bandages that deliver higher pressure at the ankle and decrease proximally. Dott. Tommaso Richelmi prescribes 20‑30 mmHg for mild disease and 30‑40 mmHg for moderate‑to‑severe insufficiency or active ulcer. A meta‑analysis of 12 randomized trials showed that sustained compression at 30‑40 mmHg reduces ulcer recurrence by 40 % over 12 months compared with no compression. Proper fitting and regular replacement every 3‑6 months are essential to maintain therapeutic pressure.