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1、SomeimportantpointsinVenousLegUlcersWhydopatientswithchronicvenousinsufficiencydevelopVLU?CVImostcommoncauseofVLUVLUpatientshavevenoushypertension,orabnormallysustainedelevationofvenouspressureonwalkingCausedbyveinvalvereflux,outflowproblemsorbothVenousoutflowissuesVenousobstruc
2、tionPoorfunctionofcalfmusclepumpimpairsvenoussystem'sabilitytoreturnvenousbloodtoheartAnklemovementlimitationscontributetocalfmusclepumpfailureWhataretheriskfactorsforVLU?Ageolderthan55yearsFamilyhistoryofCVIUlcerhistory,parentalhistoryofankleulcersHigherbodymassindexHistoryofpu
3、lmonaryembolismVenousrefluxindeepveins,historyofsuperficial/DVTLowerextremitiesskeletalorjointdiseaseNumberofpregnanciesPhysicalinactivitySeverelipodermatosclerosisAretheremeasuresthatcanpreventVLUortheirrecurrence?AggressivemanagementofreversibleriskfactorsControlofrelevantcomo
4、rbidconditions(CHF,PVD)Healthydiet,appropriateexercise,weightcontrolManagementofahypercoagulablestateStockingsthatachieveatleast20-30mmHgpressurePatientsshouldusehighestlevelofcompressiontolerableSurgicalvenousablationCLINICALBOTTOMLINE:Prevention...CVIistheleadingcauseofVLUVeno
5、ushypertensionwithcalfmusclepumpdysfunctionManagecomorbidriskfactorsCVI,obesity,hypercoagulablestatesSkeletalandjointdiseaseofthelowerextremitiesCompressionstockingsForprimaryandsecondarypreventionVenousinterventionForsecondarypreventionWhatsymptomsandphysicalfindingsaresuggesti
6、veofCVI?Swellingandachingoflegs,worseatendofdayandimprovedbylegelevationHistoryofulcerrecurrence,particularlyatsamelocationDependentedema,telangiectasias,varicoseveins,reddish-brownpigmentationandpurpura,andsubsequenthemosiderindepositionEczematouschangeswithredness,scaling,prur
7、itusSmooth,ivory-white,stellateatrophicplaquesofsclerosiswithtelangiectases(atrophieblanche)Chroniclipodermatosclerosis(LDS)andacuteLDSChronicvenousinsufficiencyAtrophieblancheWhatsymptomsandphysicalfindingssuggestthatVLUareduetoCVI?VLUmaybepainful—dull,aching,orburningpainLocat
8、ionovermediallowerthirdofthelegsUsually1ulcerw/
