Peripheral Vascular Disease

Question 1

ESSENCE

Answer 1

Blood does not effectively drain from legs back to heart, usually due to damage of valves inside veins

Blood pools in veins causing venous hypertension, leading to skin changes

Question 2

CLINICAL FEATURES

Presentation

Answer 2

• Haemosiderin staining
• Venous eczema
• Lipodermatosclerosis
• Atrophie blanche
• Cellulitis
• Poor healing after injury
• Skin ulcers
• Pain

Question 3

INVESTIGATIONS

First choice

Answer 3

• Not usually required
• Consider duplex US

Question 4

MANAGEMENT

General principles

Answer 4

• Keep the skin healthy
• Improve venous drainage to legs
• Manage complications

Question 5

MANAGEMENT

How is skin kept healthy

Answer 5

• Monitoring skin health and avoiding skin damage
• Regular use emollients (eg diprobase, oilatum, cetraben and doublebase)
• Topical steroids to treat flares of venous eczema
• Very potent topical steroids to treat flares of lipodermatosclerosis

Question 6

MANAGEMENT

Improving venous drainage of legs

Answer 6

• Weight loss
• Keep active
• Keep legs elevated when resting
• Compression stockings (exclude arterial disease first with ABPI)

Question 7

MANAGEMENT

Of complications

Answer 7

• Antibiotics for infection
• Analgesia for pain
• Wound care for ulceration