Document Detail

Pulsating varicose veins!! The diagnosis lies in the heart.
MedLine Citation:
PMID:  16681546     Owner:  NLM     Status:  MEDLINE    
Right heart failure is associated with increased systemic venous pressure, which can be diagnosed clinically with the findings of elevated jugular venous pressure, pulsatile liver and distinctive cardiac murmurs (precordial systolic). Severe tricuspid regurgitation (TR) has occasionally been known to lead to marked pulsation of varicose veins. We report three cases that were referred to the vascular clinic of Royal Perth Hospital in which the patients involved had unilateral (right leg) varicose veins and chronic venous ulcers. On clinical examination all three patients had pulsations along the course of the varicose long saphenous vein up to the mid calf. The main differential diagnosis was arterio-venous malformation, which was excluded by compression of the sapheno-femoral junction and demonstrating absence of pulsation in the long saphenous vein. A venous duplex scan showed a grossly incompetent sapheno-femoral junction with abnormal wave forms. Two of the cases were managed conservatively with compression dressing. The option of sapheno-femoral junction ligation was reserved in one patient who had unsettling cellulitis and oedema of the lower limb in spite of compression dressing and optimal conservative management. All three patients had improvement in ulcer size at 3-month follow up with compression therapy. This article highlights that in cases of right heart failure the venous pressures can be felt as low as the mid calf level and that can be a cause of the venous ulcers. There should be a high suspicion of right heart failure in patients with late onset venous insufficiency.
Manzoor Abbas; Mark Hamilton; Mazri Yahya; Patrice Mwipatayi; Kishore Sieunarine
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  ANZ journal of surgery     Volume:  76     ISSN:  1445-1433     ISO Abbreviation:  ANZ J Surg     Publication Date:  2006 Apr 
Date Detail:
Created Date:  2006-05-09     Completed Date:  2006-10-17     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  101086634     Medline TA:  ANZ J Surg     Country:  Australia    
Other Details:
Languages:  eng     Pagination:  264-6     Citation Subset:  IM    
Department of Vascular Surgery, Royal Perth Hospital, Perth, Australia.
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MeSH Terms
Heart Failure / complications*,  physiopathology
Pulsatile Flow / physiology
Saphenous Vein / ultrasonography
Ultrasonography, Doppler, Duplex
Varicose Ulcer / etiology*,  physiopathology,  ultrasonography

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