Differential diagnosis of leg ulcers

2013 ◽  
Vol 28 (1_suppl) ◽  
pp. 55-60 ◽  
Author(s):  
F Pannier ◽  
E Rabe
Keyword(s):  
Differential Diagnosis ◽  
Varicose Veins ◽  
Correct Diagnosis ◽  
Duplex Ultrasound ◽  
Underlying Disease ◽  
Chronic Venous Disease ◽  
Venous Disease ◽  
Leg Ulcers ◽  
Swedish Population ◽  
Venous Ulcers

Leg and foot ulcers are symptoms of very different diseases. The aim of this paper is to demonstrate the differential diagnosis of leg ulcers. The majority of leg ulcers occur in the lower leg or foot. In non-venous ulcers the localization in the foot area is more frequent. The most frequent underlying disease is chronic venous disease. In 354 leg ulcers, Koerber found 75.25% venous leg ulcers, 3.66% arterial leg ulcers, 14.66% ulcers of mixed venous and arterial origin and 13.5% vasculitic ulcers. In the Swedish population of Skaraborg, Nelzen found a venous origin in 54% of the ulcer patients. Each leg ulcer needs a clinical and anamnestic evaluation. Duplex ultrasound is the basic diagnostic tool to exclude vascular anomalies especially chronic venous and arterial occlusive disease. Skin biopsies help to find a correct diagnosis in unclear or non-healing cases. In conclusion, chronic venous disease is the most frequent cause of leg ulcerations. Because 25% of the population have varicose veins or other chronic venous disease the coincidence of pathological venous findings and ulceration is very frequent even in non-venous ulcerations. Leg ulcers without the symptoms of chronic venous disease should be considered as non-venous.

Superficial Venous Disease

2018 ◽  
pp. 287-298
Author(s):  
Ronald S. Winokur ◽  
Geraldine Abbey-Mensah ◽  
Neil M. Khilnani
Keyword(s):  
Venous Insufficiency ◽  
Varicose Veins ◽  
Treatment Options ◽  
Duplex Ultrasound ◽  
Chronic Venous Disease ◽  
Venous Disease ◽  
Venous Ulcers ◽  
Patient Morbidity ◽  
And Performance ◽  
Superficial Venous Insufficiency

Superficial venous insufficiency (SVI) is an extremely common condition affecting up to 39% of Americans, which results in significant patient morbidity and high healthcare costs (up to $3 billion per year for treatment). In addition to patients with asymptomatic spider veins and painful varicose veins, over 2 million adults have advanced chronic venous disease (CVD), and at least 20,000 individuals develop new venous ulcers each year. Patients suffering from venous insufficiency can benefit greatly from office-based, minimally invasive treatments. Successful treatment depends on understanding of superficial venous anatomy and pathophysiology, how to conduct a targeted history and physical exam, and performance and interpretation of Duplex ultrasound (DUS), as well as knowledge and application of the available treatment options.

Duplex Ultrasound Scanning for Chronic Venous Disease: I. Techniques for Examination of the Crural Veins

1994 ◽  
Vol 9 (3) ◽  
pp. 108-113 ◽  
Author(s):  
R. W. Ziegenbein ◽  
K. A. Myers ◽  
P. G. Matthews ◽  
G. H. Zeng
Keyword(s):  
Venous Insufficiency ◽  
Outcome Measure ◽  
Varicose Veins ◽  
Duplex Ultrasound ◽  
Chronic Venous Disease ◽  
Venous Disease ◽  
Ultrasound Scanning ◽  
Diagnostic Laboratory ◽  
Non Invasive ◽  
Anterior Tibial

Objective: To describe a practical technique to reliably find and study crural veins by duplex ultrasound scanning. Design: Prospective scanning of patients referred for evaluation of possible chronic deep venous insufficiency. Setting: A non-invasive vascular diagnostic laboratory in Melbourne, Australia. Patients: A study of 1340 legs in 917 consecutive patients referred with primary or recurrent varicose veins, or for evaluation of possible deep venous disease causing aching or swelling in the legs. Interventions: Examination of the crural veins by duplex ultrasound scanning. Main outcome measure: Identification of all three sets of crural veins. Results: Rates for detecting the posterior tibial, anterior tibial and peroneal veins were 97%, 92% and 91% respectively and all three were observed in 91%. If the last 1227 legs studied by colour-Doppler duplex ultrasound are considered, the rates for detection were 98%, 96% and 96% respectively. Conclusion: Examination of the crural veins can be a part of routine duplex ultrasound scanning in patients referred with suspected venous disease.

Chronic venous disease: Correlation between ultrasound findings and the clinical, etiologic, anatomic and pathophysiologic classification

2013 ◽  
Vol 29 (8) ◽  
pp. 522-527 ◽  
Author(s):  
Predrag A Matić ◽  
Hristina D Vlajinac ◽  
Jelena M Marinković ◽  
Miloš Ž Maksimović ◽  
Đorđe J Radak
Keyword(s):  
Clinical Signs ◽  
Duplex Ultrasound ◽  
Cross Sectional Study ◽  
Chronic Venous Disease ◽  
Venous Disease ◽  
Strongly Correlated ◽  
Cross Sectional ◽  
Venous Ulcers ◽  
Final Study ◽  
Color Duplex Ultrasound

Objective The aim of the study was to investigate association between clinical manifestation of chronic venous disease and the presence and severity of functional venous disease. Method A cross-sectional study was conducted in 14 towns in Serbia. All men and women aged >18 years, consecutively coming to venous specialists (47 specialists) were included in the study. Patients who were previously treated for chronic venous disease were excluded. Patients were classified according to the clinical category of clinical, etiologic, anatomic and pathophysiologic classification for chronic venous disease. Reflux and/or obstruction were determined by using a color duplex ultrasound. Results The study included 1679 chronic venous disease patients. Color duplex ultrasound was performed in 1029 (61.3%) of them who formed the final study group. Reflux was found in 76.8% of patients – 53.1% had reflux in superficial, 7.2% in deep and 16.1% in perforator veins. Obstruction was found in 31.9% of patients – superficial in 14.8% of patients and deep in 16.9%. Deep obstruction was even found in clinical, etiologic, anatomic and pathophysiologic C0s-C1 categories. Reflux and obstruction combined were revealed in 19.1% of patients. Reflux in deep and perforator veins and reflux and obstruction combined were significantly associated with clinical, etiologic, anatomic and pathophysiologic clinical categories being the most frequent in patients with venous ulcers. Conclusion Clinical, etiologic, anatomic and pathophysiologic clinical categories of chronic venous disease are strongly correlated with functional disease especially with reflux in deep and perforator veins, and reflux and obstruction combined. The presence of deep obstruction in patients with chronic venous disease belonging to clinical, etiologic, anatomic and pathophysiologic C0s-C1 category could justify recommendation for color duplex ultrasonography in all patients with symptoms of chronic venous disease but without clear clinical signs.

scholarly journals Ultrasound-guided foam sclerotherapy for chronic venous disease with ulcer. A prospective multiple outcome cohort study

2020 ◽  
Vol 19 ◽  
Author(s):  
Guilherme Camargo Gonçalves de Abreu ◽  
Otacílio de Camargo Jr. ◽  
Márcia Fayad Marcondes de Abreu ◽  
José Luis Braga de Aquino
Keyword(s):  
Quality Of Life ◽  
Cohort Study ◽  
Disease Severity ◽  
Varicose Veins ◽  
Chronic Venous Disease ◽  
Venous Disease ◽  
Leg Ulcers ◽  
Ultrasound Guided ◽  
Foam Sclerotherapy

Abstract Background Chronic Venous Disease (CVD) is the main cause of chronic leg ulcers. Varicose veins are the most frequent cause of venous leg ulcers (VLU). 50.9% of Brazilian women have varicose veins and ulcer prevalence is as high as 4%. Ultrasound-guided foam sclerotherapy (UGFS) is a low-cost treatment option for varicose veins. Objectives To analyze UGFS outcomes in patients with VLU. Methods Prospective consecutive single center cohort study. Patients with great saphenous vein (GSV) reflux and VLU were treated and followed-up for 180 days. The following were studied: quality of life (QoL), disease severity, healing, and elimination of GSV reflux. The Aberdeen questionnaire, a venous clinical severity score, and Duplex scanning (DS) results were analyzed. Results 22 patients aged 35 to 70 years were treated. There was improvement in quality of life, disease severity reduced, and ulcer diameter reduced (p < 0.001; ANOVA). 77.27% of VLU healed completely (95%CI: 59.76-94.78%). The dimensions of 20/22 VLU reduced (90.91%; 95%CI: 78.9-100%). GSV reflux was eliminated in 63.64% (95%CI: 43.54-83.74%). Men had greater QoL benefit and women had more complications. There were no severe complications. The VLU that had healed completely at the end of the study were smaller at baseline than those that did not completely heal. The GSV that were completely occluded at the end of the study were smaller at baseline than those that were not completely occluded (p < 0.05; Mann-Whitney). Conclusion The results suggest that most patients benefited from UGFS.

Diagnosis and Follow-up of Varicose Veins with Duplex Ultrasound: How and Why?

2012 ◽  
Vol 27 (1_suppl) ◽  
pp. 10-15 ◽  
Author(s):  
R D Malgor ◽  
N Labropoulos
Keyword(s):  
Varicose Veins ◽  
Financial Burden ◽  
Disease Process ◽  
Duplex Ultrasound ◽  
Chronic Venous Disease ◽  
Venous Disease ◽  
Foam Sclerotherapy ◽  
Non Invasive ◽  
Work Up

Chronic venous disease (CVD) is very prevalent and causes a significant financial burden in Western societies. Accurate diagnosis is mandatory to define the anatomy and pathophysiology involved in the disease process. Duplex ultrasound (DU) is a well-established non-invasive tool used for varicose veins work-up that, most recently, has also been utilized for follow-up after endovenous procedures such as endovenous laser or radiofrequency ablation and foam sclerotherapy. Insightful information on how DU is performed during varicose veins work-up and the rationale of DU utilization for endovenous procedures are discussed.

The Significance of Pain in Chronic Venous Disease and its Medical Treatment

2019 ◽  
Vol 17 (3) ◽  
pp. 291-297
Author(s):  
Djordje Radak ◽  
Igor Atanasijević ◽  
Mihailo Nešković ◽  
Esma Isenovic
Keyword(s):  
Varicose Veins ◽  
Compression Therapy ◽  
Interventional Therapy ◽  
Lifestyle Changes ◽  
Chronic Venous Disease ◽  
Venous Disease ◽  
Venous Ulcers ◽  
Venoactive Drugs ◽  
Micronized Purified Flavonoid Fraction ◽  
Flavonoid Fraction

Chronic venous disease (CVeD) is a highly prevalent condition in the general population, and it has a significant impact on quality of life. While it is usually manifested by obvious signs, such as varicose veins and venous ulcers, other symptoms of the disease are less specific. Among the other symptoms, which include heaviness, swelling, muscle cramps and restless legs, pain is the symptom that most frequently compels CVeD patients to seek medical aid. However, there is a substantial discrepancy between pain severity and clinically detectable signs of CVeD, questioned by several opposing studies. Further evaluation is needed to clarify this subject, and to analyse whether pain development predicts objective CVeD progression. </P><P> General management of CVeD starts with advising lifestyle changes, such as lowering body mass index and treating comorbidities. However, the mainstay of treatment is compression therapy, with the additional use of pharmacological substances. Venoactive drugs proved to be the drugs of choice for symptom alleviation and slowing the progression of CVeD, with micronized purified flavonoid fraction being the most effective one. Interventional therapy is reserved for advanced stages of the disease.

Duplex Ultrasound Scanning for Chronic Venous Disease: Recurrent Varicose Veins in the Thigh after Surgery to the Long Saphenous Vein

1996 ◽  
Vol 11 (3) ◽  
pp. 125-131 ◽  
Author(s):  
K. A. Myers ◽  
G. H. Zeng ◽  
R. W. Ziegenbein ◽  
P. G. Matthews
Keyword(s):  
Saphenous Vein ◽  
Varicose Veins ◽  
Duplex Ultrasound ◽  
Chronic Venous Disease ◽  
Injection Sclerotherapy ◽  
Venous Disease ◽  
Ultrasound Scanning ◽  
Recurrent Varicose Veins ◽  
Long Saphenous Vein ◽  
Primary Varicose Veins

Objective: To use duplex ultrasound scanning to compare limbs with recurrent and primary varicose veins and to identify connections between deep veins and recurrences. Setting: A non-invasive vascular laboratory in Melbourne, Australia. Patients: A study of 779 limbs with recurrent varicose veins previously treated by ligation or stripping of the long saphenous vein and 1521 limbs with primary varicose veins. Main outcome measures: Connections between deep veins and recurrent varices, reflux in superficial and deep veins, and outward flow in perforators as demonstrated by duplex ultrasonography. Results: Recurrence was due to reflux in the long saphenous territory in 71.8%, short saphenous reflux alone in 14.7% or outward flow in calf perforators without saphenous reflux in 5.2%, while no source was detected in 8.3%. Limbs with recurrent veins in the long saphenous territory were compared with limbs with primary varicose veins; there was more frequent outward flow in thigh perforators (25.2% vs. 16.2%) but no difference for deep reflux (20.7% vs. 17.5%) or outward flow in calf perforators (56.8% vs. 53.1%). The source for recurrence in the long saphenous territory was from a single large connection in the groin in 46.3%, multiple smaller proximal connections in a further 46.3%, or thigh perforators in 7.4%. The destination was to an intact long saphenous vein in 33.7%, major tributaries in 28.7% or to other varices in 37.6%. Limbs known to have been treated by long saphenous ligation alone were compared with those known to be treated by long saphenous ligation and stripping; the source was more likely to be from a single large vein in the groin (60.3% vs. 39.9%) and the destination was more likely to be an intact long saphenous vein or major tributary (75.0% vs. 55.2%). Conclusions: Duplex ultrasound scanning detected the source of recurrent varicose veins in over 90% of patients and demonstrated whether there were single large or multiple smaller connections in the veins affected, and this helps to select the most appropriate treatment. Recurrence after stripping the long saphenous vein was more likely to be due to multiple small connections passing to scattered varices and this may allow more simple treatment by injection sclerotherapy rather than repeat surgery.

Progression in venous pathology

2015 ◽  
Vol 30 (1_suppl) ◽  
pp. 95-97 ◽  
Author(s):  
F Pannier ◽  
E Rabe
Keyword(s):  
Varicose Vein ◽  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Varicose Veins ◽  
Chronic Venous Disease ◽  
Venous Disease ◽  
Leg Ulcers ◽  
Skin Changes ◽  
Venous Leg Ulcers

Aim To review epidemiologic data on progression of venous pathology in varicose veins and from varicose veins towards chronic venous insufficiency. Methods We searched Medline and PubMed for epidemiologic studies concerning progression of venous pathology. Results The data suggest that reflux progression may develop from segmental to multisegmental superficial reflux. In younger age, reflux in tributaries and non-saphenous veins is more frequent. In older age, more saphenous reflux develops and more proximal sites seem to be affected. A high proportion of uncomplicated varicose vein (C2) develops skin changes and chronic venous insufficiency (C3–C6). Significant risk factors for the progression of varicose vein towards venous leg ulcers are skin changes, corona phlebectatica, higher body mass index and popliteal vein reflux. During a 13.4-year follow-up period, 57.8% (4.3%/year) of all chronic venous disease patients showed progression of the disease. Summary Studies on the progression of venous pathology show a high progression rate of chronic venous disease. More follow-up studies are still needed to get better information about the risk of varicose vein patients for progression to venous leg ulcers and to answer the question which patients may benefit from early varicose vein interventions.

The Relevance of the Natural History of Varicose Veins and Refunded Care

2012 ◽  
Vol 27 (1_suppl) ◽  
pp. 23-26 ◽  
Author(s):  
F Pannier ◽  
E Rabe
Keyword(s):  
General Population ◽  
Natural History ◽  
Clinical Symptoms ◽  
Negative Impact ◽  
Varicose Veins ◽  
Chronic Venous Disease ◽  
Venous Disease ◽  
Progression Rate ◽  
Venous Ulcers ◽  
History Of

Chronic venous disease (CVD) is one of the most common diseases in our population. Aside from venous symptoms like heaviness and pain, which are present in about 50% of the general population, signs of CVD include varicose veins (VVs), oedema, eczema, venous eczema, hyperpigmentation, white atrophy, lipodermatosclerosis and venous ulcers. The aim of this paper is to review current literature for the relevance of natural history of VVs in refunded care. Available papers on VVs, progression of the disease and complications were reviewed. Prevalence of VVs is high with more than 20% in the general population. Information on progression of uncomplicated VV to chronic venous insufficiency (CVI) is rare. However, most venous ulcers have a primary venous origin. The progression rate of VV to higher clinical stages reaches 4% per year. Among the risk factors are obesity and higher age. Quality of life (QOL) is also reduced in uncomplicated VV in C2 patients. In conclusion, there is evidence from the literature that a high proportion of patients with uncomplicated VVs in the clinical, aetiological, anatomical and pathophysiological classification (CEAP Clinical Class 2) will progress to CVI if untreated. VVs have a negative impact on QOL and clinical symptoms. VV patients with CVI (C3–C6) as well as those C2 patients with severe clinical symptoms and impaired QOL due to CVD should be treated with ablation of the VVs in a refunded care system.

Short-term results of isolated phlebectomy with preservation of incompetent great saphenous vein (ASVAL procedure) in primary varicose veins disease

2016 ◽  
Vol 32 (9) ◽  
pp. 601-607 ◽  
Author(s):  
Igor A Zolotukhin ◽  
Evgeny I Seliverstov ◽  
Elena A Zakharova ◽  
Alexander I Kirienko
Keyword(s):  
Recurrence Rate ◽  
Local Anesthesia ◽  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
Varicose Veins ◽  
Duplex Ultrasound ◽  
Chronic Venous Disease ◽  
Venous Disease ◽  
Primary Varicose Veins ◽  
One Year

Objective To establish an effect of isolated phlebectomy in patients with incompetent great saphenous vein (Ambulatory Selective Varices Ablation under Local anesthesia (ASVAL) procedure) on the reflux and diameter of the trunk and to assess recurrence rate of varicose veins at one year. Material and methods We conducted a prospective study on patients with primary varicose veins and with C2 or C2,3 or C2,3,4 or C2,4 classes of chronic venous disease and great saphenous vein incompetence. The study included 67 patients (51 women and 16 men; 75 limbs in total). Age varied from 17 to 71 years; mean age was 46.8 years (SD 13.9). We recorded the presence or absence of reflux in the great saphenous vein with duplex ultrasound before and after surgery. The recurrence of varicose veins was evaluated at 12 months. All the patients underwent isolated phlebectomy with preservation of incompetent great saphenous vein (ASVAL procedure) under local anesthesia. Results At one year after removing of tributaries of the incompetent trunk, 66% of them were competent. Reflux persisted in 17% of great saphenous veins with reflux above mid-thigh and in 61% of trunks with reflux extended below the mid-thigh (p = 0.0004). The diameter of all the veins decreased significantly no matter reflux disappeared or not. Varicose veins reoccurred in 13.5% cases. In 6.5% of limbs with a reflux above the mid-thigh, the recurrence was registered at one year, while in the limbs with the reflux below the mid-thigh at a baseline, the recurrence rate was 25% (p = 0.036). Conclusion Isolated phlebectomy with a preservation of incompetent great saphenous vein leads to disappearance of reflux in a majority of cases and to significant decrease of vein diameter in all the cases. ASVAL procedure could be considered as a less aggressive and less expensive approach in selected cases. Clear indications for isolated phlebectomy need to be established.

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