小结
定义
病史和体格检查
关键诊断因素
- corona phlebectatica (malleolar flare or ankle flare)
- ankle swelling
- hyperpigmentation (brawny edema)
- lipodermatosclerosis
- atrophie blanche
- leg ulcers
其他诊断因素
- 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
危险因素
- increasing age
- family history
- smoking
- deep vein thrombosis
- orthostatic occupation
- female sex
- obesity (waist circumference)
- ligamentous laxity
诊断性检查
首要检查
- duplex ultrasound
需考虑的检查
- ascending phlebography
- CT venography
- magnetic resonance venography
- CT abdomen and pelvis
- abdomen and pelvis ultrasound
- intravascular ultrasound
- air plethysmography
治疗流程
all symptomatic patients
撰稿人
作者
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
利益声明
JLM declares that he has no competing interests.
David G. Armstrong, DPM, MD, PhD
Professor of Surgery
Director of Southwestern Academic Limb Salvage Alliance (SALSA)
Keck School of Medicine of University of Southern California (USC)
Los Angeles
CA
利益声明
DGA declares that his work is partially supported by grants from the National Institutes of Health and the National Institute of Diabetes and Digestive and Kidney Diseases.
同行评议者
Anahita Dua, MD, MS, MBA, FACS
Assistant Professor of Surgery
Massachusetts General Hospital/Harvard Medical School
Boston
MA
Declarações
AD declares that she has no competing interests.
Paul Tisi, MBBS, MS, FRCSEd
Medical Director/Consultant Vascular Surgeon
Bedford Hospital
Bedford
UK
Declarações
PT declares that he has no competing interests.
Créditos aos pareceristas
Os tópicos do BMJ Best Practice são constantemente atualizados, seguindo os desenvolvimentos das evidências e das diretrizes. Os pareceristas aqui listados revisaram o conteúdo pelo menos uma vez durante a história do tópico.
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Referências
Principais artigos
Lurie F, Passman M, Meisner M, et al. The 2020 update of the CEAP classification system and reporting standards. J Vasc Surg Venous Lymphat Disord. 2020 May;8(3):342-52. Resumo
De Maeseneer MG, Kakkos SK, Aherne T, et al. Editor's choice - European Society for Vascular Surgery (ESVS) 2022 clinical practice guidelines on the management of chronic venous disease of the lower limbs. Eur J Vasc Endovasc Surg. 2022 Feb;63(2):184-267.Texto completo Resumo
Bergan JJ, Schmid-Schönbein GW, Smith PD, et al. Chronic venous disease. N Engl J Med. 2006 Aug 3;355(5):488-98. Resumo
American Vein and Lymphatic Society (American College of Phlebology). Treatment of superficial venous disease of the lower leg. Feb 2016 [internet publication].Texto completo
Artigos de referência
Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
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