Chronic venous insufficiency

Question 1

What signs would you see suggestive of chronic venous insufficiency?

Answer 1

HASLEGS:
Haemosiderin deposition
Atrophie blanche
Swelling
Lipodermatosclerosis
Eczema
Gaiter ulcers
Scars- venous

Also varicose veins

Question 2

What is Perthes’ test?

Answer 2

Tests for deep venous occlusion

Question 3

How do you perform Perthes’ test?

Answer 3

High tourniquet around the patient’s leg, walk for 5 minutes

If a deep obstruction is present, this –> swelling and pain

Question 4

How would you differentiate venous and arterial claudication?

Answer 4

Venous claudication –> a “bursting” pain in the leg after exercise and is relieved by rest

cf arterial, venous claudication is improved by elevating the leg

Question 5

What would you need to ask about in a history of a patient with suspected post-phlebitic limb?

Answer 5

Past DVT- especially re any orthopaedic surgery or complicated obstetric course

Signs of venous claudication

Question 6

What is venous gangrene?

Answer 6

A rare complication of DVT in the ileofemoral segment

Question 7

What are the signs and symptoms of venous gangrene?

Answer 7

3 phases: 1. White leg

2. Blue leg
3. Gangrene secondary to acute ischaemia

Question 8

What is lipodermatosclerosis?

Answer 8

A panniculitis due to venous hypertension. Poor tissue oxygenation results in ulceration and fat necrosis. The inverted champagne bottle appearance results from fibrosis causing distal shrinkage and venous obstruction causing proximal leg swelling.

Question 9

What are the surgical options for treating venous reflux?

Answer 9

Trahere transplantation- axillary vein segment with valve transplanted into deep venous system

Valvuloplasty of damaged valves.

Question 10

What are the surgical options for treating venous obstruction?

Answer 10

Palma operation- use contralateral great saphenous vein and anastomose to femoral vein to bypass ileofemoral obstruction