Peripheral Venous Disease

Question 1

A 33 yo pregnant female presents complaining of a dull ache and heaviness in her legs. She says her legs are fatigued by prolonged standing but are relived with elevation. On exam you see a dilated, tortuous superficial lower extremity vein. What is the diagnosis? What is the pathological cause?

Answer 1

Varicose Veins

Distended vein –> weakened valve –> venous dilation

Question 2

A pt presents with asymptomatic unilateral leg swelling. She is on Coumadin but thinks she forgot a dose or two a few days ago. U/S shows a thrombus in her leg. What complications are you worried about?

Answer 2

PE
Post Thrombotic syndrome
Phelgmasia alba dolens - white leg, total occlusion, reversible
Plegmasia cerulean dolens - venous gangrene d/t continued phlegmatic alba dozens (amputation)

Question 3

A pt presents with localized pain in his hand. The area is indurated, warm, red, and there is a tender red cord. The pt tells you that he recently had an IV in the back of his hand in the area that is now hurting. What is the most likely diagnosis? What treatment do you recommend?

Answer 3

Superficial venous thrombosis

Supportive Tx: elevation, warm compress, NSAIDs

Question 4

A 65 yo female presents with itching, a dull ache in her leg, and taut skin over her ankle. You note pitting edema which she claims is new. Duplex U/S shows superficial reflux and moderate deep reflux. What treatment do you recommend?

Answer 4

Chronic Venous Insufficiency
Compression stockings! (gold standard)
Avoid prolonged sitting/standing and elevate legs above heart
Surgery

Question 5

A pt presents with unilateral leg tenderness and pitting edema. He has an increased calf circumference compared to the unaffected leg and a positive Homan’s sign. What do you suspect? What diagnostic tests should you run?

Answer 5

DVT
Well's Criteria
D-dimer (good to R/O)
U/S (MC)
MR venography w/ dye

Question 6

A pt presents concerned about a dilated, tortuous vein she noticed in her leg. She is asymptomatic except for a brownish pigmentation around the vein. What diagnostic test should you run? What treatment do you recommend? What do you recommend if the pt complains about the cosmetic appearance of her condition?

Answer 6

Varicose Vein
Duplex U/S (gold standard!)
Non-surgical: avoid prolonged standing, compression stocking, leg elevation
Surgical: endogenous ablation, greater saphenous stripping, phlebectomy, compression sclerotherapy

Question 7

What is the MC location for varicose veins?

Answer 7

Greater Saphenous

Question 8

A pt presents with localized pain in his thigh. The area is indurated warm, red, and tender. He tells you he has Berger’s Dz and he injured the area yesterday. What do you suspect? How will you treat him?

Answer 8

Superficial Venous Thrombosis

Anticoagulation (if thigh/arm thrombus)

Question 9

An obese female presents with leg pain, unilateral pitting edema, and a white leg. She is currently on a BCP. U/S shows a thrombus and abnormal flow on the Doppler. How will you treat this pt?

Answer 9

DVT
Immediate anti-coagulation!!! (Heparin, fondaparinux)
Long-term anti-coagulation
IVC filter