Venous Disease

VENOUS DISEASE

Deep vein thrombosis (DVT) usually affects deep leg veins (90%), with iliac, femoral,and popliteal veins being particularly commonly affected. It is often asymptom-atic and is consequently a commonly missed diagnosis. When symptomatic, it can produce unilateral leg swelling with warmth, erythema, and positive Homan sign (increased resistance to passive dorsiflexion of the ankle by the examiner). The diag-nosis can be established with doppler “duplex” ultrasound. The major complication is pulmonary embolus.

Varicose veins are dilated, tortuous veins caused by increased intraluminal pressure.

A variety of veins can be affected.

·            Superficial veins of the lower extremities are particularly vulnerable due toa lack of structural support from superficial fat and/or incompetent valve(s). Varicosities of these superficial veins are very common (15% of the U.S. popu-lation); occur more frequently in females than males; and are common in pregnancy.

·            Esophageal varices are due to portal hypertension (usually caused by cirrho-sis) and may be a source of life-threatening hemorrhage.

·            Varices of the anal region are commonly called hemorrhoids; are associated with constipation and pregnancy; and may be complicated by either bleeding (streaks of red blood on hard stools) or thrombosis (painful).

Venous insufficiency is more common in women than men, and the incidenceincreases with age. Lower extremities demonstrate edema, hyperpigmentation and ulceration due to venous hypertension and incompetent valves.

Vascular ectasias:

·            Nevus flammeus nuchae is a neck “birthmark” or “stork bite” that regresses.

·            Port wine stain is a vascular birthmark that does not regress.

·            Spider telangiectasias occur on the face, blanch with pressure, and are associ-ated with pregnancy.