CLINICAL FEATURES OF VENOUS HYPERTENSION OF THE LE

CLINICAL FEATURES OF VENOUS HYPERTENSION OF THE LEG

The following clinical features are commonly seen: /uni25CF Varicose vein: subcutaneous dilated vein 3 /uni00A0 mm in diameter or larger. They are frequently elongated and tortuous, with intermittent ‘blowouts’, but are defined by the presence of reflux and may be straight and uniform tubes morpho logically ( Figure 62.3 ). /uni25CF Telangiectasia (thread veins, spider veins and hyphen webs): represent tiny intradermal venules less than 1 /uni00A0 mm in diameter ( Figure 62.4 ). Maurice Klippel , 1858–1942, neurologist, La Salpêtrière, Paris, France. Paul Trénaunay , 1875–1938, French neurologist. Klippel and Trénaunay described this condition in a joint paper in 1900. A gaiter is a leather or cloth covering for the lower leg and ankle. The name is derived from the French ‘guetre’ for the same piece of clothing. /uni25CF Reticular vein: small dilated ‘bluish’ subdermal vein 1–2.9 /uni00A0 mm in diameter, usually tortuous, can be di ffi cult to distinguish this from a normal subdermal vein in someone with white thin transparent skin. /uni25CF Saphena varix ( Figure 62.5 ) is a (usually painless) groin swelling apparent on standing. /uni25CF Corona phlebectatica (malleolar flare): a fan-shaped pat - tern of telangiectasia on the ankle or foot. This is an early , sign of advanced venous disease. /uni25CF Oedema: increased volume of fluid in the skin and soft tis - sues of the leg. Commonly starts distally and moves more proximally with increasing venous dysfunction. Classically this is ‘pitting oedema’, with firm digital pressure leaving an indentation in the soft tissues. /uni25CF Eczema: an erythematous dermatitis, often appears minor, although it may be associated with significant itching and discomfort. In extreme cases it may progress to blistering and weeping ( Figures 62.6–62.8 ). /uni25CF Pigmentation (haemosiderosis): a brownish discoloration of the skin, usually permanent. It is usually seen around the ankle, but is also seen in proximity to varicose veins and - incompetent perforators ( Figures 62.7 and 62.9 ). /uni25CF Lipodermatosclerosis (LDS): chronic inflammation and fibrosis of the skin and subcutaneous tissues, resulting in a tight, contracted, ‘woody’ leg on examination. It occa - sionally results in significant contractures of the Achilles

(c) varicose veins in the

tendon. This is a sign of severe chronic venous disease ( Figures 62.6 and 62.9 ). /uni25CF Atrophie blanche: localised areas of atrophic, white skin, often surrounded by telangiectasia and pigmentation. Some authors distinguish this from the white scarring left by ulceration; others do not. Either way , this is a sign of severe chronic venous disease ( Figure 62.6 ). /uni25CF V enous ulcer: full-thickness skin loss, usually around the ankle, which fails to heal spontaneously and is propagated by continuing venous hypertension and the changes associ ated with chronic venous disease ( Figure 62.10 ).

Figure 62.4 Telangiectasia and reticular veins. Figure 62.5 A saphena varix.