Venous ulceration/Venous insufficiency (Complete) Flashcards
What are venous ulcers?
Ulcers formed due to long-standing venous hypertension
What is chronic venous insufficiency?
Condition in which vessels of the leg are unable to effectively drain blood back to the heart.
What is the aetiology behind chronic venous insufficiency?
Caused by damage to valves of the veins which can be to multitude of reasons.
Damaged valves results in regurgitation and hence reduces venous return and results in pooling of blood in the legs
Prolonged pooling then leads to skin changes within the legs
What are some of the causes of chronic venous insufficiency?
Age
Obesity
Immobility (assuming lack of muscle contraction to help venous return resulting in congestion and hence valve damage)
Prolonged standing
DVT
Chronic venous insufficiency is typically associated with which other condition?
Varicose veins
What are some risk factors for chronic venous insufficiency? (5)
Age
Female sex
Orthostatic occupation
DVT
Family history of chronic venous disease
What are the main signs/symptoms of chronic venous insufficiency?
Skin changes:
Haemosiderin staining
Venous eczema: itchy, flaky, red dry skin
Hardening/thickening of the skin (lipodermatosclerosis)
Narrowing of the lower legs (Invered champagne bottle appearance)
Atrophie blanche: Smooth-white scar tissue sorrounded by hyperpigmentation.
Other features:
Pain
Leg fatigue or heaviness (worsens throughout day)
Cellulitis (tends to be bilateral)
Venous ulcers
Poor healing after injury
Varicose veins
What is haemosiderin staining?
Red/Brown discoloration of skin due to deposition of haemoglobin from damaged vessels in CVI
N.B. Haemosiderin is a breakdown product of haemoglobin
Hardening/thickening of the skin seen in patients with CVI is known as?
Lipodermatosclerosis
Smooth-white scar tissues sorrounded by areas of hyperpigmentation seen in patients with CVI is known as?
Atrophie blanche
Venous ulcers tend to be located within which regions of the leg?
Proximal to medial malleolus
Gaiter area (between malleolus and mid-calf)
How can venous ulcers be distinguished from neuropathic or arterial ulcers?
Tend to present around medial malleolus region
Shallow and sloughy (dead tissue looking)
What is the management plan for chronic venous insufficiency and venous ulcers?
Lifestyle advice:
Keep ulcer clean
Encourage mobility
Weight reduction
Leg elevation at rest
Conservative
Compression bandaging (usually four layer)
Medical:
Peripheral vasodilator: oral pentoxifylline (to improve healing rate if failure to heal with inital treatment)
Topical steroids: Treat venous eczema [mild] and lipodermatosclerosis [strong steroid]
Surgical: Only in severe cases
Debridement
Skin grafting
What investigation MUST be performed before treating a venous ulcer with compression bandages?
ABPI to exclude co-commitment arterial disease as bandaging will worsen arterial supply to the leg.
N.B. Values below 0.9 indicate arterial disease
What is debridement?
Removal of dead, damaged or infected tissue of a wound
