Venous insufficiency and leg swelling

Perhaps one of the least understood problems we as vascular surgeons face is venous insufficiency.  Venous insufficiency affects approximately 200 million Americans, and is far more prevalent that peripheral vascular disease (PAD).  The reason why it is so under diagnosed is that it can take many different forms and symptoms, raging from leg swelling, to spider and varicose veins, to skin discoloration, to frank ulceration of the skin with non-healing wounds (see picture).  I will post another time about varicose veins and venous insufficiency. In this post, we will deal with leg swelling.  In my opinion, venous insufficiency is either the most or second most likely cause for leg swelling.  Typically, the swelling occurs below the knee, is relieved by elevation, and lead to minor discomfort, to severe pain.  The diagnosis is made by history and physical examination, followed by a venous Doppler.  The venous Doppler is best done by a vascular lab that is sensitive to studying vein valve function.  As obvious as this sounds, it is not often studies as a routine in most vascular labs.  Next time I will go into the work up and management of venous reflux and leg swelling

venous ulcer

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