In current times, VLUs have a major socioeconomic effect that is related to several factors:

1. their prevalence, which ranges between 0.06% and 2%;
2. their common occurrence, representing up to 80% of all leg ulcers;
3. their predilection for recurrence of 50% to 70% within 6 months.

As a result, the current direct cost of treatment for VLUs in the United States amounts to $10,000 to $12,000 per year per patient and a comparable figure in Germany. Thus, the direct expenditures for treatment of VLU may amount to 1% of the health care budgets for some European countries. The indirect costs are also significant due to the lost productivity from work for the patient and the family members taking care of him or her, out-of-pocket expenses (copays), transportation, and premature disability.

The current guideline is the direct result of an American Venous Forum (AVF)-sponsored initiative "to reduce the incidence of VLU by 50% over the next decade". A number of strategies were formulated at the Sixth Pacific Vascular Conference to achieve that goal, and guideline development was a major component of a multipronged approach to reduce the incidence of VLU. The AVF Venous Ulcer Committee formed at that conference responded to a request for proposal from the Society for Vascular Surgery (SVS) Guidelines Committee. The current VLU guideline represents a joint sponsored effort between the SVS and AVF and includes input from experts representing different specialties interested in care of VLUs. We are appreciative of the review and subsequent endorsement of these guidelines by the American College of Phlebology (ACP) and the Union Internationale de Phlébologie (UIP) in an effort to make this an intersocietal document. Both the ACP and the UIP submitted comments on the document to which we responded.