Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- corona phlebectatica (malleolar flare or ankle flare)
- ankle swelling
- hyperpigmentation (brawny oedema)
- lipodermatosclerosis
- atrophie blanche
- leg ulcers
Other diagnostic factors
- leg fatigue, aching, and/or discomfort
- heavy legs
- leg cramps
- telangiectasias
- reticular veins
- dilated tortuous veins
- dry and scaly skin
- skin burning and itching
- unilateral leg swelling
Risk factors
- increasing age
- family history
- smoking
- deep vein thrombosis
- orthostatic occupation
- female sex
- obesity (waist circumference)
- ligamentous laxity
Diagnostic investigations
1st investigations to order
- duplex ultrasound
Investigations to consider
- ascending phlebography
- CT venography
- magnetic resonance venography
- CT abdomen and pelvis
- intravascular ultrasound
- air plethysmography
Treatment algorithm
all symptomatic patients
Contributors
Authors
Joseph L. Mills Sr, MD
Professor and Chief
Division of Vascular Surgery and Endovascular Therapy
Michael E. DeBakey Department of Surgery
Baylor College of Medicine
Houston
TX
Disclosures
JLM declares that he has no competing interests.
David G. Armstrong, DPM, MD, PhD
Professor of Surgery
Director of Southern Arizona Limb Salvage Alliance (SALSA)
Department of Surgery
University of Arizona College of Medicine
Tucson
AZ
Disclosures
DGA declares that he has no competing interests.
Peer reviewers
Raouf A. Khalil, MD, PhD
Division of Vascular Surgery
Brigham and Women's Hospital
Boston
MA
Disclosures
RAK has received NIH research funds greater than 6 figures USD. RAK has no other competing interests.
Paul Tisi, MBBS, MS, FRCSEd
Medical Director/Consultant Vascular Surgeon
Bedford Hospital
Bedford
UK
Disclosures
PT declares that he has no competing interests.
Mark D. Iafrati, MD
Chief of Vascular Surgery
Tufts Medical Center
Boston
MA
Disclosures
MDI is the author of a study referenced in this monograph.
Differentials
- Diabetic foot ulcer
- Arterial ulcer
- Squamous cell carcinoma (Marjolin)
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