Chronic Venous Disease

  • This relates to abnormalities of the deep venous system, as opposed to the superficial venous system (varicose veins)
  • The presentation is chronic as opposed to acute DVT: typically it is caused by DVT ("post-phlebitic syndrome")
  • Typical features are chronic swelling and discoloration, with lipodermatsclerosis, which can progress to ulceration

​Assessment

Signs and Symptoms

  • Chronically swollen limb (often permanent, brawny swelling)
  • Skin changes – pigmentation with hardness of the subcutaneous tissues (lipodermatosclerosis)
  • Bursting pain in limb on walking which settles with elevation or compression
  • Ulceration

History and Examination

History:
  • Previous DVT, pulmonary embolism or significant limb trauma
  • Risk factors for DVT, including family history
  • Previous ulcers
Examination:
  • Chronically swollen limb
  • Skin changes (eczema, lipodermatosclerosis)
  • Normal arterial circulation (pulses palpable/biphasic Doppler signal /ABPI greater than 1)
  • Ulceration

Differential Diagnoses

  • Systemic causes of limb swelling (bilateral)
  • Lymphoedema (swelling extends onto toes – pigmentation unusual)
  • Acute DVT
  • Venous compression (pelvic mass / anatomic abnormalities)

Investigations

  • Arterial assessment

Management

  • Compression therapy – usually well fitted Class 2 below knee stocking
  • Care of the skin (moisturise)

Joint formulary - Chapter 13, section 13.1 Dry and scaling skin conditions

Referral

Referral Criteria

  • Patients whose symptoms have become a persistent and significant disability
  • Patients in whom there is doubt about the diagnosis
  • Chronic unilateral limb swelling in the absence of a history of DVT (consistent with pelvic compression or anatomic abnormality) – in these cases an ultrasound or CT scan should be considered before or at the time of referral
  • Ulceration (for detailed arterial and venous assessments)

Referral Instructions

Routine referral to vascular specialist

e-Referral Service Selection

  • Specialty: Surgery - Vascular
  • Clinic Type: Not otherwise specified
  • Service: DRSS-South Devon & Torbay-Surgery Vascular- Devon CCG -15N

Referral Forms

DRSS referral form

Torbay and South Devon seeking advice form

Supporting Information

Pathway Group

This guideline has been signed off by Alex Rowe on behalf of South Devon and Torbay CCG.

Publication date: June 2015

 

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