Where are venous ulcers usually found?
Medial malleolus
What causes venous ulceration?
Venous hypertension which is causes by a calf pump failure
What is deep venous insufficiency and what is it caused by?
Similar pathophysiology to varicose veins but just affects deep veins not superficial
Failure of the venous system due to valvular reflux, venous hypertension and obstruction, leading to pain/ulcers/swelling
Usually caused by DVT or valvular insufficiency
What are some risk factors for deep venous insufficiency?
- Increasing age
- Female
- Pregnancy
- Previous DVT or phlebitis
- Obesity
- Smoking
- Long periods of standing
What are some of the presenting features of deep venous insufficiency?
- Chronically swollen lower limbs which can be aching, pruitic, painful
- Venous claudication which is pain on walking which resolves on leg elevation
- Signs like varicose eczema, thromophlebitis, haemosiderin skin staining, lipodermatosclerosis, atrophie blanchae, pitting oedema
- Venous ulcers
What is post thrombotic syndrome?
Syndrome that occurs after DVT
- Heaviness
- Cramps
- Pain
- Pruitic
- Paraesthesia
- Pretibial oedema
- Venous ectasia
- Hyperpigmentation
- Ulceration
How is deep venous insufficiency diagnosed?
- Doppler US: assess extent of venous reflux, look for stenosis, rule out DVTs and varicose veins
- Routine blood tests: FBC, U+Es LFTs and ECHO to rule out other causes such as cardiac
- Document foot pulses and ABPI
How is deep venous insufficiency managed?
Early management reduces long term complications
Conservative (more common)
- Compression stockings, if venous ulcer do 4 layer bandage
- Suitable analgesia
- Elevate foot above level of heart
Surgical (less effective)
- Valvuloplasty
- Venous stenting
What are some complications of deep venous insufficiency?
- Swelling
- Recurrent cellulitis
- Chronic pain
- Ulceration
Less common: DVT, secondary lymphoedema, varicose veins
