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Post-Phlebitic Limb: Chronic Venous Insufficiency (Viva (Lipodermatosclero…
Post-Phlebitic Limb: Chronic Venous Insufficiency
Examination
Inspection
HAS LEGS
Haemosiderosis
Atrophie blanche
Swelling
Lipodermatosclerosis
Eczema
Gaiter ulcers
Stars, venous
Varicose Veins
Often present as collaterals bypassing the obstruction
Palpation
Pitting oedema
Completion
Perthes’ Test
Tests for deep venous occlusion
High tourniquet around pts. leg + walking for 5min
Deep obstruction → swelling and pain
Abdominal exam + PR
Pelvic exam in women
Viva
Hx
Previous DVT
Orthopaedic surgery
Complicated obstetric course
Venous Claudication
“Bursting” pain in the leg after exercise
Relieved by rest and elevation of limb (cf. arterial)
Causes
Reflux following DVT: 90%
Obstruction following DVT: 10%
Venous Gangrene
Rare complication of DVT in the iliofemoral segment
3 phases
Phlegmasia alba dolens: white leg
Phlegmasia cerulea dolens: blue leg
Gangrene secondary to acute ischaemia
Lipodermatosclerosis
Panniculitis
Venous HTN → extravasation of fibrin and red cells
Poor tissue oxygenation → ulceration and fat necrosis
Inverted champagne bottle appearance
Chronic inflam → fibrosis → distal shrinkage
Venous obstruction → proximal leg swelling
Ix of Deep Venous Disease
Duplex: reflux and occlusion
Venography
Ascending: patency and perforator incompetence
Descending: reflux
Ambulatory venous pressures
Surgical Options
Reflux
Trahere Transplantation
Transplant segment of axillary vein w/ valve into
deep venous system of leg
Wrap w/ PTFE cuff
Kistner Operation
Valvuloplasty of damaged valves
Obstruction
Palma operation
Use contralateral GSV and anastomose to
femoral vein to bypass iliofemoral obstruction