Chronic Venous Insufficiency & Stasis Ulcerations: Clinical Examination [PDF]

Chronic Venous Insufficiency & Stasis Ulcerations: Clinical Examination Steven M. Dean, DO, FACP, RPVI Associate Professor of Medicine Division of Cardiovascular Medicine The Ohio State University Wexner Medical Center

Disclosures No Relevant Disclosures

Eklöf B et al. Revision of the CEAP classification for chronic venous disorders: consensus statement. J Vasc Surg 2004;40:1248-52.

C1: Spider Veins or Telangiectasias • Non raised dilated intradermal veins/venules • Typically < 1 mm in diameter • Appear earlier than varicose veins • Blue or Red

Dilated, non-palpable subcutaneous veins Blue-green 1-3 mm Sometimes coexist with and “feed” telangiectasias Prominent along the popliteal fossa

 Dilated, tortuous, palpable subcutaneous veins > 3 mm (upright)  Synonyms: varix, varices, varicosities  Truncal: branches of great and/or small saphenous veins (GSV/SSV)  Non truncal: fed by perforating veins

>C3 = CVI Eklöf B et al. Revision of the CEAP classification for chronic venous disorders: consensus statement. J Vasc Surg 2004;40:1248-52.

Swelling [C3] Chronic stasis dermatitis [C4a] Stasis pigmentation [C4a]

: Acute (early) Lipodermatosclerosis (LDS) • Acute inflammation within the distal medial calf • DDX: cellulitis, superficial thrombophlebitis

Chronic Lipodermatosclerosis Inverted “Champagne Bottle” or “Bowling Pin” Legs

Identify the abnormality by the ARROW 1. Venous stasis ulcer 2. Capillary malformation 3. Atrophie blanche 4. Corona phlebectatica

Atrophie Blanche (C4b)

Identify the abnormality by the arrow 1. Venous malformation 2. Capillary malformation 3. Reticular veins 4. Corona phlebectatica “Ankle flare sign”

Blue or Red Telangiectasias

Corona phlebectatica “Ankle flare” sign

J Vasc Surg 2012;55:150-3

Atrophie Blanche [C4b]

Posterior or Lateral Calf Stasis ulceration = Small Saphenous Vein Reflux

• Frequently confused with varicose veins

• Usually found on the anterolateral calf • Bulge disappears with dorsiflexion of the foot • No flow is audible with continuous-wave Doppler examination

Minocycline Hyperpigmentation Stasis hyperpigmentation?

Closing Remarks / Thank You

Chronic Venous Insufficiency & Stasis Ulcerations: Clinical Examination Steven M. Dean, DO, FACP, RPVI Associate Professor of Medicine Division of Cardiovascular Medicine The Ohio State University Wexner Medical Center