Venous ulceration is an important disorder affecting about 1% of the adult population and is associated with a significant reduction in quality of life. Post-thrombotic syndrome is a well-known risk factor for leg ulcerations. Approximately 40%-60% of patients with Deep Venous Thrombosis (DVT) suffer from post-thrombotic syndrome; about 10% of them develop venous leg ulceration. Factor V Leiden (FVL) mutation is considered a well-established risk factor for venous thrombosis. Patients with DVT and thrombophilic risk factors have an increased risk of post-thrombotic syndrome because DVT occurs earlier in life and is often recurrent and extensive. More than 40% of patients with chronic venous ulceration have at least one thrombophilic risk factor. FVL mutation was reported to be more frequent in patients with venous leg ulceration than control subjects.

We report a 46-year-old male patient with thrombosed varicose veins and venous skin ulceration around the left internal malleolus. His medical history included DVT about 3 years ago. The heterozygous FVL mutation was detected. His venous leg ulceration improved with a combination of venoactive drug therapy and four-layer compression dressings.