Venous stasis: Difference between revisions
Spenceemmett (talk | contribs) |
|||
| (7 intermediate revisions by 4 users not shown) | |||
| Line 5: | Line 5: | ||
==Clinical Features== | ==Clinical Features== | ||
[[File:Chronicvenousinsufficiency.jpg|thumb|Long term venous stasis skin changes]] | |||
[[File:PMC3152448 mjhid-3-1-e2011026f2.png|thumb|Chronic venous stasis ulcer.]] | |||
===Venous stasis dermatitis=== | ===Venous stasis dermatitis=== | ||
*Skin becomes darker/purple, dry, tight, and hairless | *Skin becomes darker/purple, dry, tight, and hairless | ||
**In severe cases may see venous insufficiency ulcers | **In severe cases may see venous insufficiency ulcers | ||
*Patients may complain of leg heaviness, fatigue, or cramping | *Patients may complain of leg heaviness, fatigue, or cramping | ||
*Unlike cellulitis erythema from venous stasis tends to change with dependent positioning of the affected limb | *Unlike [[cellulitis]], erythema from venous stasis tends to change with dependent positioning of the affected limb | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
| Line 22: | Line 23: | ||
*[[Compartment syndrome]] | *[[Compartment syndrome]] | ||
*[[Complex regional pain syndrome]] | *[[Complex regional pain syndrome]] | ||
{{Unilateral leg swelling DDX}} | |||
==Evaluation== | ==Evaluation== | ||
| Line 31: | Line 34: | ||
==Disposition== | ==Disposition== | ||
*Discharge | *Discharge | ||
*Considerations for admission to medicine or surgery for ulcers:<ref>Dogra S, Sarangal R. Summary of recommendations for leg ulcers. Indian Dermatol Online J. 2014;5(3):400-407. doi:10.4103/2229-5178.137829</ref> | |||
**Patients with significant occlusive arterial disease require specialist assessment of the severity | |||
**For treatment of underlying medical problems such as rheumatoid arthritis, peripheral vascular disease, diabetes mellitus, etc. | |||
**Ulcers with mixed etiologies, diabetic ulcers | |||
**Suspected malignant ulcers | |||
**Nonhealing ulcers (a minimum of at least 6 months of compression and local wound care followed by reassessment of venous function should be done before operative plastic surgical intervention is considered) | |||
**Rapid deterioration of the ulcer | |||
**Recurrent ulcers | |||
**Reduced ABPI <0.8 or increased ABPI >1.0 | |||
**Infected foot | |||
**Ischemic foot | |||
==See Also== | ==See Also== | ||
| Line 36: | Line 50: | ||
==External Links== | ==External Links== | ||
*https://www.uptodate.com/contents/overview-and-management-of-lower-extremity-chronic-venous-disease?search=venous%20stasis&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1#H10 | |||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:Vascular]] | |||
Latest revision as of 16:57, 11 March 2021
Background
- Decreased rate of return of venous blood flow to heart (most commonly in lower extremities)
- Leads to characteristic vascular and skin changes
- Common in individuals with chronic vascular disease, diabetes, obesity, smoking history, prolonged immobility
Clinical Features
Venous stasis dermatitis
- Skin becomes darker/purple, dry, tight, and hairless
- In severe cases may see venous insufficiency ulcers
- Patients may complain of leg heaviness, fatigue, or cramping
- Unlike cellulitis, erythema from venous stasis tends to change with dependent positioning of the affected limb
Differential Diagnosis
- Cellulitis
- Deep venous thrombosis
- Critical limb ischemia
- Peripheral artery disease
- Ruptured Baker cyst
- Superficial thrombophlebitis
- Necrotizing fasciitis
- Compartment syndrome
- Complex regional pain syndrome
Unilateral leg swelling
- Gravitational
- Venous stasis
- Thrombophlebitis
- Lymphedema
- Medications
- Deep venous thrombosis (uncomplicated)
- Leg or foot infection
- Fracture
- Compartment syndrome
- Limb hypertrophy
- Hypertrophy of soft tissue or bone (Klippel-Trenaunay syndrome)
- Overgrowth of body part (Proteus Syndrome)
- Lipedema
- Tumor
- Post-thrombotic Syndrome
- Causes of bilateral pedal edema
Evaluation
- Duplex scan if suspicion for DVT
Management
- Limb elevation, compression, and increased exercise
Disposition
- Discharge
- Considerations for admission to medicine or surgery for ulcers:[1]
- Patients with significant occlusive arterial disease require specialist assessment of the severity
- For treatment of underlying medical problems such as rheumatoid arthritis, peripheral vascular disease, diabetes mellitus, etc.
- Ulcers with mixed etiologies, diabetic ulcers
- Suspected malignant ulcers
- Nonhealing ulcers (a minimum of at least 6 months of compression and local wound care followed by reassessment of venous function should be done before operative plastic surgical intervention is considered)
- Rapid deterioration of the ulcer
- Recurrent ulcers
- Reduced ABPI <0.8 or increased ABPI >1.0
- Infected foot
- Ischemic foot
See Also
External Links
References
- ↑ Dogra S, Sarangal R. Summary of recommendations for leg ulcers. Indian Dermatol Online J. 2014;5(3):400-407. doi:10.4103/2229-5178.137829