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Venous Stasis Ulcer

Chronic disturbances of venous blood flow are associated with vein dilation, functional impairment of vascular walls and surrounding tissues as well as local inflammation. Minor trauma to affected tissues may result in poor wound healing and venous stasis ulcer.


Presentation

Venous stasis primarily occurs in body regions situated below the heart. Granulation tissue is often visible at the base of the ulcer. For physical reasons, the lower legs are most frequently affected. Ulcers are commonly situated over bony prominences because these sites are more prone to trauma. Still, patients may not associate a VSU with any traumatic event. They are irregularly shaped, shallow cutaneous lesions of varying size. Edematous swelling, erythema and shiny skin consistent with stasis dermatitis may be noted in close proximity to VSU [6]. Lipodermatosclerosis and atrophie blanche are commonly observed [7]. Patients may claim tenderness and dull aching pain in regions affected by VSU. In the case of systemic disorders, symptoms occur bilaterally. In contrast, post-traumatic VSU and similar conditions are generally limited to one leg.

Plethora
  • Clinicians can determine the appropriate type of dressing for ulcers by the appearance of tissue type on the ulcer base (see “How To Select The Optimal Dressing For Venous Ulcers” at left).11 Depending on the wound type and drainage amount, there are a plethora[podiatrytoday.com]
Foul Smelling Discharge
  • Venous stasis ulcers may: Be painful and itchy Be discolored, darkened, and scaly skin around the edges Have foul-smelling discharge from the wound if an infection is present You will be asked about your symptoms and health history.[health.cvs.com]
Aspiration
  • A computed tomography scan subsequently identified a suspicious inguinal lymph node, and an ultrasound-guided needle aspiration revealed metastatic squamous cell carcinoma of the biopsied lymph node.[ncbi.nlm.nih.gov]
Quickening
  • […] treatment of VSUs that fail to close or show signs of healing despite good conventional wound and compression therapy. 13,16,21 Surgery In some cases, especially in those patients with severe VSUs, surgery may be warranted and may decrease venous reflux, quicken[uspharmacist.com]
Calf Pain
  • The symptoms of stasis dermatitis include: skin discoloration itching scaling ulcers You may also experience symptoms of venous insufficiency , including: leg swelling calf pain calf tenderness a dull ache or heaviness in your legs that gets worse when[healthline.com]
Foot Pain
  • My foot pain may not rule the rest of my life after all! I believe I'll make a sign that reads, "THE END IS NEAR!"[foot-pain-explained.com]
Ankle Pain
  • I found you based on my ankle pain search and am happy to realize that there may be a relatively simple cause and solution.... Natalie unknown location ...Thanks for your fantastic service.[foot-pain-explained.com]
Skin Ulcer
  • Venous skin ulcers, or venous stasis ulcers, are often caused by a venous reflux disorder, a chronic condition that prevents toxic venous blood from being pumped back to the heart.[goldmanveininstitute.com]
  • Venous skin ulcers are shallow wounds that develop when the leg veins do not circulate blood back to the heart normally. In such cases, blood tends to pool near the ankle as gravity pulls fluid and blood downward.[mmcoakridge.com]
  • There are a variety of skin ulcers. Most people are somewhat familiar with decubitus ulcers, more commonly known as pressure sores (and also sometimes called bedsores).[excelas1.com]
  • Venous stasis (purplish skin) ulcers are common in patients who have a history of leg swelling, varicose veins or a history of blood clots in either the superficial or deep veins of the legs.[premierveincenter.com]
Compulsive Disorder
  • Our patient had a history of dementia, obsessive-compulsive disorder, peripheral vascular disease and chronic lower extremity wounds. She was not a candidate for revascularization according to the few records that were available.[nursing.advanceweb.com]
Renal Insufficiency
  • A fasting chemistry screens for diabetes and renal insufficiency. Albumin and prealbumin give a snapshot of the patient’s nutritional status. Consider liver function tests if history or symptoms indicate.[nursing.advanceweb.com]
Enlarged Uterus
  • uterus Obesity or weight gain — Excessive weight accelerates the progression of varicose veins and other manifestations of chronic venous disease Surgery or injury (especially near the pelvis) — Blood flow in damaged veins can be restricted Prolonged[vascareclinics.com]

Workup

Leg ulcers are very common and are diagnosed clinically. Anamnestic data generally support the diagnosis of VSU. Because these ulcers occur in patients suffering from chronic disease, affected individuals typically have a medical history of venous insufficiency, varicose veins, phlebitis and/or eczematous dermatitis. Complaints associated with these pathologies subside when the legs are elevated.

In case of doubt, further measures are required to distinguish VSU from ulcers resulting from arterial disorders and vasculitis [8]:

  • Duplex ultrasonography may be employed to assess blood flow and vascular anomalies [9], and this method has largely replaced invasive angiography and venography.
  • Air plethysmography is a non-invasive technique that allows for an evaluation of venous reflux and calf muscle function [7].

It is important to note that malignancies may develop from chronic wounds like VSU [10]. In this context, biopsy specimens should be obtained for histopathological and immunohistochemical analyses.

Treatment

  • The whirlpool treatment followed by vigorous rinsing was found to remove more than four times as many bacteria as the whirlpool treatment alone.[ncbi.nlm.nih.gov]
  • Treatment of leg ulcers is expensive. Is costs an estimated 5000 GBP per patient for three months of conventional treatment.[oceansidehyperbaric.ca]
  • We highly recommend consulting a vascular surgeon early in the treatment process. Essential Insights On Treatment The most important goal for the treatment of venous leg ulcers is long-term edema control.[podiatrytoday.com]

Prognosis

Etiology

  • METHODS: A retrospective review of patients with active VSUs (clinical, etiology, anatomy, and pathophysiology [CEAP] classification C6) that received EVLA of the GSV or combined EVLA of the GSV and IPV between May 2005 and May 2010 was completed.[ncbi.nlm.nih.gov]
  • etiology surgical options: chronic venous insufficiency: emedicine vascular surgery stasis dermatitis: emedicine dermatology venous ulcers are treated with compression of the leg to minimize edema or swelling. compression treatments include wearing compression[allnurses.com]
  • The exact etiology of venous stasis disease is not certain, but is thought to arise when venous valves that exist to prevent backflow of blood do not function properly.[utsurgery.com]

Epidemiology

  • Epidemiology The point prevalence of venous stasis ulceration western nations is estimated to be from 0.02 to 1 percent.1 Risk factors include age, obesity, history of leg injury and history of venous thromboembolism (VTE).[centerforvein.com]
  • Venous ulcer: epidemiology, physiopathology, diagnosis and treatment. Int J Dermatol. 2005;44(6):449–56. Alguire PC, Mathes BM. Medical management of lower extremity chronic venous disease.[woundcareadvisor.com]
  • Epidemiology of Venous Stasis Ulcers It has been estimated that the prevalence of venous stasis ulcers in the general population is around 0.3 per cent or 3 patients per 1,000.[veinguide.com]
Sex distribution
Age distribution

Pathophysiology

  • METHODS: A retrospective review of patients with active VSUs (clinical, etiology, anatomy, and pathophysiology [CEAP] classification C6) that received EVLA of the GSV or combined EVLA of the GSV and IPV between May 2005 and May 2010 was completed.[ncbi.nlm.nih.gov]
  • Understanding the basic physiology of the venous system makes the pathophysiologic mechanisms clearer.[nursing.advanceweb.com]
  • Venous Stasis Ulcer Pictures Picture 1 : Venous Stasis Ulcer Image source : veinsveinsveins.com Picture 2 : Venous Stasis Ulcer on back of Leg Image source : veinsveinsveins.com Pathophysiology of Venous Stasis Ulcer Venous stasis ulcer is idiopathic[howshealth.com]
  • Curiously, although decubitus ulcers have been known of for thousands of years, the exact pathophysiology has not been elucidated.[centerforvein.com]

Prevention

  • The increase in pressure and buildup of fluid prevents nutrients and oxygen from getting to tissues. SYMPTOMS Venous stasis ulcers are often an early sign of venous insufficiency.[athensveins.com]
  • Preventing VSUs is the most important aspect of CVI management.[woundcareadvisor.com]

Summary

Venous blood flow depends on the activity of the surrounding musculature as well as cardiac function [1]:

  • On the one hand, leg muscles literally pump venous blood up the lower limbs against gravity while venous valves impede the blood to sink back to lower body regions. In patients suffering from venous insufficiency, however, these valves don't close properly.
  • On the other hand, cardiovascular disorders associated with functional impairment of the right heart and venous congestion may hinder the undisturbed return of venous blood to the heart. Such pathologies may thus impose disproportionate burdens on venous valves and walls.

Both venous insufficiency and cardiovascular disease - often occurring concomitantly - may thus result in venous hypertension and blood stasis. Moreover, venous stasis may be related to a mechanical obstruction of veins, as is the case in patients suffering from vein thrombosis. Less common causes of venous stasis include phlebitis, malignancy [2], post-traumatic formation of an arteriovenous fistula [3], and congenital malformations [4], among others.

Venous stasis may affect superficial veins, a common condition known as varicose veins, or deep veins. In any case, chronic venous stasis leads to structural changes in venous walls and surrounding tissues. It has been suggested that fibrin leakage may result in the development of perivascular fibrinogen cuffs that hinder the passage of oxygen, nutrients and a variety of other molecules to dependent tissues. In the case of a traumatic lesion, this condition would largely impair wound healing and predispose for the onset of venous stasis ulcer (VSU). Of note, other hypotheses have been proposed regarding the pathogenesis of VSU [5].

References

Article

  1. Eberhardt RT, Raffetto JD. Chronic venous insufficiency. Circulation. 2014;130(4):333-346.
  2. Labropoulos N, Manalo D, Patel NP, Tiongson J, Pryor L, Giannoukas AD. Uncommon leg ulcers in the lower extremity. J Vasc Surg. 2007;45(3):568-573.
  3. Young CJ, Dardik A, Sumpio B, Indes J, Muhs B, Ochoa Chaar CI. Venous ulcer: late complication of a traumatic arteriovenous fistula. Ann Vasc Surg. 2015;29(4):836.e831-833.
  4. Phair J, Trestman E, Stableford J. Venous status ulcers due to congenital agenesis of the inferior vena cava in a 16-year-old male. Vascular. 2016;24(1):106-108.
  5. Pocock ES, Alsaigh T, Mazor R, Schmid-Schonbein GW. Cellular and molecular basis of Venous insufficiency. Vasc Cell. 2014;6(1):24.
  6. Trayes KP, Studdiford JS, Pickle S, Tully AS. Edema: diagnosis and management. Am Fam Physician. 2013;88(2):102-110.
  7. Alavi A, Sibbald RG, Phillips TJ, et al. What's new: Management of venous leg ulcers: Approach to venous leg ulcers. J Am Acad Dermatol. 2016;74(4):627-640; quiz 641-622.
  8. Pannier F, Rabe E. Differential diagnosis of leg ulcers. Phlebology. 2013;28 Suppl 1:55-60.
  9. Gornik HL, Sharma AM. Duplex ultrasound in the diagnosis of lower-extremity deep venous thrombosis. Circulation. 2014;129(8):917-921.
  10. Eliassen A, Vandy F, McHugh J, Henke PK. Marjolin's ulcer in a patient with chronic venous stasis. Ann Vasc Surg. 2013;27(8):1182.e1185-1188.

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Last updated: 2019-07-11 21:18