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Also known as

Post phlebetic syndrome

Post thrombotic leg

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CAUSES

Congenital absence of venous valves

Trauma leading to damage to valves

Deep venous thrombosis

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PATHOPHYSIOLOGY

irreversible damage to the valve.

During normal ambulation, calf muscles

decrease venous pressures by

approximately 70% in the lower extremities.

With rest, pressures return to normal inapproximately 30 seconds. In diseased

veins, ambulation decreases venous

pressures by only 20%.

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Ambulatory venous hypertension

Low-flow states within the capillaries cause

leukocyte trapping.

release proteolytic enzymes and oxygen

free radicals, which damage capillarybasement membranes.

Plasma proteins, such as fibrinogen, leak

into the surrounding tissues, forming afibrin cuff.

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Interstitial fibrin and

resultant edema

decrease oxygen delivery

to the tissues, resulting in

local hypoxia.Inflammation and tissue

loss result.

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CLINICAL FEATURES

Leg swelling

Leg discomfort

Varicose veins

Lipodermatosclerosis

Nonhealing ulcers

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IMAGING STUDIES

Doppler bidirectional-flow studies and

Doppler color-flow studies

to assess venous flow, its direction, and

the presence of thrombus.

Venography

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MEDICAL THERAPY

Leg elevation

Compression stockings

Anticoagulation

Phlebotonics no established role

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SURGICAL THERAPY reserved for those with discomfort or ulcers

refractory to medical management.

Chronic venous insufficiency resulting from

superficial vein disorders

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Vein ligation for varicose veins in the

absence of deep venous disease

Clot lysis and thrombectomy

Saphenous vein crossover graft

Vein segment transposition

Valvuloplasty

Vein valve transplantation

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DEFINITION

a chronic non-healing wound on leg or foot

that takes longer than six weeks to heal

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CAUSES OF LEG ULCERS

Venous Causes - 60% 70%

Arterial Causes - 20%

Other Causes

Rheumatoid ulcers

Traumatic

Neuropathic (diabetic)

neoplastic

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VENOUS LEG ULCERS

Blood stasis theory

AV fistula theory

Fibrin cuff theory

THE REASON FOR ALL IS AMBULATORY

VENOUS HYPERTENSION

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CLINICAL FEATURES

Situated in gaiter area

Sloping edge

Base contains granulation tissue

Surrounding lipodermatosclerosis

Varicose veins +

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LIPODERMATOSCLEROSIS

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ALWAYS EXAMINE

For varicosities

Arterial system

Sensation and proprioception

joints

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INVESTIGATE

ROUTINE

Blood CP

ESR

Sickle cell test

Blood glucose

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SPECIAL

Arterial Doppler

Duplex assessment of venous system

venography

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MANAGEMENT

Compression bandaging regimen

Dressings

Biological dressings

Excision and graft

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