Post-phlebitic limb
Approach
- Expose patient legs
- Lying comfortably on bed
- Inspection
- Features of chronic venous insufficiency
- Swelling
- dilated veins
- skin pigmentation
- Venous eczema
- Lipodermatosclerosis
- Venous ulceration
- Palpation
- Compare temperature of both legs
- Check for pitting oedema
- Percussion
- Ausculation
Completion
- Test for deep venous occlusion (Perthes' test)
- Place high tourniquet around top of patient's thigh and ask them to walk
- If deep venous system occluded - leg will become swollen and blue with dilated superifical veins distal to tourniquet
Venous gangrene
- Rare complication of Deep vein thrombosis
- Presentation in three stages
- Phlegmasia alba dolens (white leg)
- Phlegmasia cerulea dolens (blue leg)
- Gangrene - occurs as consequence of acute ischaemia and may be restricted to the foot or spread up the leg
Investigations in Deep venous disease
- Uss Duplex: reflux and deep venous occlusion
- Venography: identifies deep venous patency and perforator incompetence
- Varicography: shows sites of communication
- Ambulatory venous pressues ("gold standard" investigation)
Surgical Options
- Reflux
- Tahere transplantation - segment of axillary vein with valve inserted into deep venous system of le, wrapping it in a PTFE cuff
- Kistner's operation: valvuloplasty of damaged veins
- Obstruction
- Palma operation: use contralateral LSV and anastamose to femoral vein to bypass iliofemoral obstruction
- Warren bypass - use LSV to bypass deep venous blockage - no longer used
