Venous stasis

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

Long term venous stasis skin changes

Chronic venous stasis ulcer.

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

Differential Diagnosis of Pedal Edema

• Gravitational
• Venous stasis
• Thrombophlebitis
• Lymphedema
• Medications
  • NSAIDS
  • Birth control
  • Steroids
• Deep venous thrombosis (uncomplicated)
  • Phlegmasia alba dolens
  • Phlegmasia cerulea dolens
• Leg or foot infection
  • Cellulitis
  • Necrotizing fasciitis
  • Septic Joint
• 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
  • CHF
  • Pretibial myxedema
  • Renal failure
  • Liver failure
  • Hypoalbuminemia

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:
  • 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

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