Venous stasis: Difference between revisions
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*[[Compartment syndrome]] | *[[Compartment syndrome]] | ||
*[[Complex regional pain syndrome]] | *[[Complex regional pain syndrome]] | ||
{{Unilateral leg swelling DDX}} | |||
==Evaluation== | ==Evaluation== | ||
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==Disposition== | ==Disposition== | ||
*Discharge | *Discharge | ||
*Considerations for admission to medicine or surgery for ulcers: | *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 | **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. | **For treatment of underlying medical problems such as rheumatoid arthritis, peripheral vascular disease, diabetes mellitus, etc. | ||
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**Reduced ABPI <0.8 or increased ABPI >1.0 | **Reduced ABPI <0.8 or increased ABPI >1.0 | ||
**Infected foot | **Infected foot | ||
**Ischemic foot | **Ischemic foot | ||
==See Also== | ==See Also== | ||
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==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]] | [[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