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Vascular · London

A leg ulcer clinic, that heals the ulcer at its cause.

A consultant vascular surgeon, ABPI and duplex on the first visit, then the right treatment - compression, EVLA or RFA venous ablation, arterial revascularisation, or a diabetic foot MDT - to heal your ulcer and keep it healed.

A stethoscope on a clinical desk

Indicative pricing

What a private leg ulcer clinic costs in the UK.

Indicative ranges across London private vascular units.

In short

£350-£650, healing programme 12-24 weeks.

Service Indicative range
Initial vascular consult + ABPI + venous duplex £350-£650
Arterial duplex (if ABPI abnormal) £280-£450
Weekly compression bandaging (per visit) £80-£150
Foam sclerotherapy of feeding varicosities £850-£1,600
EVLA or RFA superficial venous ablation £2,400-£4,500
Negative pressure wound therapy (VAC, per week) £280-£450
Specialist wound MDT programme (12 weeks) £2,400-£4,500
Second-opinion review of prior notes and imaging £250-£450

Prices vary by unit, by consultant, by whether ablation is done under local or general anaesthetic, and by the size and duration of the ulcer.

The problem

An ulcer bandaged without a diagnosis is an ulcer that will not heal.

A substantial minority of leg ulcers are not purely venous. Compression on a mixed or arterial ulcer, without an ABPI, is unsafe. The workup has to come first.

  • Is it really a venous ulcer?

    Around 15% are arterial and 10% are mixed. Without an ABPI and duplex, the wrong treatment is applied and the ulcer does not heal.

  • Should you have your veins ablated?

    EVRA trial evidence: early EVLA, RFA or foam sclerotherapy plus compression heals venous ulcers faster and reduces recurrence.

  • Is it a diabetic foot ulcer instead?

    A neuropathic diabetic foot ulcer needs podiatry, offloading and osteomyelitis workup - not just a bandage.

Ulcer aetiology

Not every leg ulcer is a venous ulcer.

The eight patterns most often seen, from the common venous ulcer to the rare Marjolin transformation that must never be missed.

  • Venous leg ulcer (VLU, around 70%)

    Chronic venous insufficiency with incompetent superficial or deep veins. Shallow, exudative, sited over the gaiter area and medial malleolus.

  • Arterial ulcer (around 15%)

    Peripheral arterial disease. Punched-out, painful, pale and dry, sited on the lateral leg or distal foot with weak or absent foot pulses.

  • Mixed arterio-venous ulcer (around 10%)

    Coexistent venous reflux and PAD. Full compression is unsafe until arterial supply is defined and, if needed, revascularised first.

  • Neuropathic diabetic foot ulcer (around 5%)

    A painless ulcer under a callus at a plantar pressure point. Needs MDT with podiatry, offloading and osteomyelitis workup.

  • Pressure ulcer (sacral or heel)

    Immobility-related tissue breakdown at bony prominences. Managed with pressure redistribution, debridement and staged wound care.

  • Rare causes: vasculitis, pyoderma, calciphylaxis

    Atypical morphology, rapid progression or purple undermined edges point to inflammatory or systemic disease. Biopsy is mandatory.

  • Malignant transformation (Marjolin ulcer)

    A long-standing ulcer that changes shape, bleeds or grows a rolled edge must be biopsied. Marjolin change is a squamous-cell carcinoma.

  • Red flag: non-healing beyond six months

    Any ulcer that has not healed within six months of correct treatment needs biopsy, MDT review and reassessment of the diagnosis.

Treatment options

From the ABPI to the class 3 stocking - the full toolkit.

Compression is the backbone. Venous ablation, arterial revascularisation and the diabetic foot MDT are the levers that heal the underlying cause.

  • ABPI and venous duplex - the workup

    ABPI is mandatory before any compression. Duplex maps great and small saphenous vein incompetence, perforator disease, and rules out DVT.

  • Four-layer compression (Profore, 3C)

    The gold standard for venous ulcers with a normal ABPI. Achieves around 70% healing at 12 weeks when applied by a trained vascular nurse.

  • Two-layer compression (Coban 2)

    A lower-profile alternative to four-layer, well tolerated in shoes and often better for older or thinner-skinned patients.

  • EVLA, RFA and MOCA venous ablation

    Endovenous laser, radiofrequency and mechanochemical ablation of the incompetent trunk. EVRA trial: early ablation plus compression heals faster than compression alone.

  • Foam sclerotherapy and VenaSeal

    Ultrasound-guided foam for tortuous varicosities and perforators. VenaSeal cyanoacrylate glue closes the trunk without heat or tumescent anaesthetic.

  • Arterial revascularisation

    Angioplasty with or without stent, or bypass, for arterial and mixed ulcers. Smoking cessation and statin therapy are part of the same plan.

  • Diabetic foot MDT

    Podiatry, orthotics, diabetic team, vascular and microbiology. Offloading with a total contact cast or removable air-cast. Probe-to-bone and MRI for osteomyelitis.

  • Advanced wound care (NPWT, skin substitutes)

    Negative pressure wound therapy (VAC), Apligraf, Dermagraft, Integra dermal substitutes, PRP and stem cell adjuncts for stalled wounds.

Safety and recovery

What to expect, and what must not be skipped.

Compression works when the diagnosis is right. The things worth insisting on are the ABPI, the biopsy for atypical ulcers, and the stocking that stops recurrence.

  • ABPI before any compression

    Full compression on an ulcer with ABPI below 0.8 can cause ischaemic damage. ABPI is mandatory and non-negotiable before the first bandage.

  • Pain that worsens under bandaging

    New or worsening pain after bandaging is not normal. Remove the bandage and be reviewed the same day - it can signal ischaemia or infection.

  • Clinical infection, not swab colonisation

    Cellulitis, spreading erythema, fever or a sudden change in exudate needs antibiotics. Routine wound swabs on a stable ulcer are not helpful.

  • Biopsy any atypical or non-healing ulcer

    Atypical edges, purple undermining or failure to heal beyond six months needs a punch biopsy to exclude vasculitis, pyoderma gangrenosum or Marjolin change.

  • DVT rule-out at first duplex

    Acute or chronic DVT changes the plan entirely. Duplex looks for compressibility and, where relevant, iliac vein obstruction (May-Thurner).

  • Diabetic foot needs an MDT, not just a bandage

    A diabetic foot ulcer without podiatry, offloading and osteomyelitis workup is undertreated, and belongs with a specialist diabetic foot service.

  • Compression stocking maintenance for life

    Once the ulcer heals, class 3 compression stockings prevent recurrence. Skipping them is the commonest reason ulcers come back.

  • Skin care between dressings

    Emollient to the surrounding gaiter skin reduces varicose eczema, itch and cellulitis risk. Written instructions provided.

  • Red flags after discharge

    Fever, spreading redness, sudden pain, dark exudate or a bandage that feels tight and cold - call the unit or attend A&E the same day.

Reading your vascular notes

Your ulcer plan in four parts. Read the last one first.

Whichever unit sees you, the plan the vascular consultant writes keeps to the same shape.

A UK vascular consultant reviewing a leg ulcer plan
  1. 01 Header

    Aetiology, size and ABPI

    Whether venous, arterial, mixed, diabetic or atypical. Ulcer size in centimetres, depth, site and the ABPI in each leg.

  2. 02 Imaging

    Duplex findings and DVT status

    Great and small saphenous vein reflux, perforator incompetence, deep vein patency and any iliac obstruction (May-Thurner).

  3. 03 Plan

    Compression, ablation or revascularisation

    The exact bandaging regime, whether EVLA, RFA, foam or VenaSeal is indicated, and any arterial or diabetic MDT referral.

  4. 04 Impression

    Healing timeline and recurrence plan

    Read this first: expected healing at 12 and 24 weeks, and the class of compression stocking you will wear for life afterwards.

Recognised by major UK insurers

BupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealix

Cover for leg ulcer clinics varies by insurer - vascular consultations, duplex and superficial venous ablation are usually funded when medically indicated.

Frequently asked

Common questions about leg ulcers.

Quick answers on ABPI, ablation, diabetic foot pathways and stopping recurrence.

  • What is a leg ulcer clinic and who runs it?

    A leg ulcer clinic is a consultant-led vascular service for open wounds on the leg or foot that have not healed within two weeks. It is run by a vascular surgeon, supported by tissue viability nurses, with same-day ABPI, venous duplex and, where needed, arterial imaging - not a nurse-only bandaging list.

  • Why is ABPI so important before compression?

    The ankle-brachial pressure index (ABPI) shows whether the arteries to the foot are patent. Full four-layer compression on a leg with an ABPI below 0.8 can cause ischaemic damage and even limb loss. ABPI is mandatory before the first bandage - if any clinic offers compression without measuring it, walk away.

  • How much does a private leg ulcer clinic cost in the UK?

    An initial consultation with ABPI and venous duplex is roughly £350 to £650. Weekly compression bandaging is £80 to £150. EVLA or RFA superficial venous ablation is £2,400 to £4,500. A specialist wound MDT programme is £2,400 to £4,500.

  • Should I have my veins ablated as well as compression?

    For most venous leg ulcers, yes. The EVRA trial showed that early superficial venous ablation (EVLA, RFA or foam sclerotherapy) added to compression heals ulcers significantly faster than compression alone, and reduces recurrence. It is worth raising at the first consultation.

  • My ulcer is on my diabetic foot - is this the right clinic?

    A diabetic foot ulcer needs an MDT with podiatry, orthotics, the diabetic team, vascular surgery and microbiology. A dedicated diabetic foot service is the right setting, ideally with same-day access to offloading (total contact or removable air-cast), MRI and probe-to-bone testing for osteomyelitis, and revascularisation if PAD is present.

  • What if my ulcer will not heal after six months?

    Any ulcer that has not healed within six months of correct treatment needs a full reassessment. A punch biopsy is mandatory to exclude vasculitis, pyoderma gangrenosum, calciphylaxis and Marjolin transformation (squamous-cell carcinoma).

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