Swollen lower limb1 General assessment and deep vein thrombosis

W Peter Gorman, Karl R Davis, Richard Donnelly The most common cause of leg swelling is oedema, but expansion of all or part of a limb may be due to an increase in any tissue component (muscle, fat, blood, etc). A correct diagnosis requires consideration of whether the swelling is acute or chronic, symmetrical or asymmetrical, localised or generalised, and congenital or acquired. Chronic swelling, particularly if asymmetrical, is usually a sign of chronic oedema arising from venous or lymphatic...

Info

High priority Medium priority Low priority abnormality. Generally, if the only abnormality is superficial venous incompetence this should be surgically corrected. If, however, the deep veins are incompetent, then superficial surgery will not help and the patient should be treated with a topical steroid and wear compression hosiery. Whose varicose veins should be treated In the absence of clear national guidelines the decision about who should receive varicose vein surgery under the NHS is being...

ABC of arterial and venous disease Acute stroke

Acute stroke is now a treatable condition that deserves urgent specialist attention. Drug treatment and specialist care both influence survival and recovery. This article considers the optimal approaches to diagnosis and early management. Stroke, a sudden neurological deficit of presumed vascular origin, is a clinical syndrome rather than a single disease. It is a common and devastating condition that causes death in one third of patients at six months and leaves another third permanently...

ABC of arterial and venous disease Renal artery stenosis

Kevin McLaughlin, Alan G Jardine, Jon G Moss Renal artery stenosis is becoming increasingly common because of atherosclerosis in an ageing population. Patients usually present with hypertension and varying degrees of renal impairment, although silent renal artery stenosis may be present in many patients with vascular disease. Despite improvements in diagnostic and interventional techniques, controversy remains over whether, when, and how to revascularise the kidneys of patients with renal...

Jl

Varicose Eczema

Skin pigmentation is due to haemosiderin deposition. This patient also has thrombophlebitis of the long saphenous vein with overlying pigmentation arrow Crepe bandaging to compress vein and minimise propogation of thrombus Analgesia preferably non-steroidal anti-inflammatory drug Crepe bandaging to compress vein and minimise propogation of thrombus Analgesia preferably non-steroidal anti-inflammatory drug Varicose eczema occurs over prominent varicose veins and in the lower third of the leg. It...

F V

Duplex Saphenofemoral Junction Reflux

Spiral computed tomogram of both carotid systems showing a tight stenosis in the proximal segment of left internal carotid artery H H MjHH.it Magnetic resonance angiography has developed rapidly over the past five years. It has the advantage of imaging a moving column of blood and does not require ionising radiation or iodinated contrast, but the technique has obvious drawbacks in terms of cost efficiency and accessibility to scanners. A variety of imaging sequences are used depending on the...

ABC of arterial and venous disease Varicose veins

Saphenous Vein Woman

Varicose veins are tortuous, twisted, or lengthened veins. Unless the enlargement is severe, size alone does not indicate abnormality because size can vary depending on ambient temperature and, in women, hormonal factors. In addition, normal superficial veins in a thin person may appear large, whereas varicose veins in an obese person may be hidden. Varicose veins can be classified as trunk, reticular, or telangiectasia. Telangiectasia are also referred to as spider veins, star bursts, thread...

Secondary prevention of transient ischaemic attack and stroke

Cerebellar Infarction

Kennedy R Lees, Philip M W Bath, A Ross Naylor Stroke or transient ischaemic attack is common and likely to be fatal or cause serious disability. A second stroke will not necessarily be of the same type as the initial event, although haemorrhages tend to recur. Patients with previous stroke commonly succumb to other vascular events, in particular myocardial infarction. Effective secondary prevention depends on giving attention to all modifiable risk factors for stroke as well as treating the...

ABC of arterial and venous disease Ulcerated lower limb

Ulceration of the lower limb affects 1 of the adult population and 3.6 of people older than 65 years. Leg ulcers are debilitating and painful and greatly reduce patients' quality of life. Ulcer healing has been shown to restore quality of life. Lower limb ulceration tends to be recurrent, and the total annual cost of leg ulceration to the NHS has been estimated at 400m. Mixed venous-arterial disease Necrobiosis lipoidica diabetecorum Venous disease, arterial disease, and neuropathy cause over...

ABC of arterial and venous disease Acute limb ischaemia

Marble Leg Acute Limb Ischemia

Limb ischaemia is classified on the basis of onset and severity. Complete acute ischaemia will lead to extensive tissue necrosis within six hours unless the limb is surgically revascularised. Incomplete acute ischaemia can usually be treated medically in the first instance. Patients with irreversible ischaemia require urgent amputation unless it is too extensive or the patient too ill to survive. Apart from paralysis inability to wiggle toes or fingers and anaesthesia loss of light touch over...

ABC of arterial and venous disease Chronic lower limb ischaemia

Palpating Femoral Pulse

Peripheral vascular disease commonly affects the arteries supplying the leg and is mostly caused by atherosclerosis. Restriction of blood flow, due to arterial stenosis or occlusion, often leads patients to complain of muscle pain on walking intermittent claudication . Any further reduction in blood flow causes ischaemic pain at rest, which affects the foot. Ulceration and gangrene may then supervene and can result in loss of the limb if not treated. The Fontaine score is useful when...

Noninvasive methods of arterial and venous assessment

Biphasic Doppler Waveform

Richard Donnelly, David Hinwood, Nick J M London Although diagnostic and therapeutic decisions in patients with vascular disease are guided primarily by the history and physical examination, the use of non-invasive investigations has increased significantly in recent years, mainly as a result of technological advances in ultrasonography. This article describes the main investigative techniques. Principles of vascular ultrasonography In the simplest form of ultrasonography, ultrasound is...