SU27.5-6 | Lower Limb Venous Disorders — Summary & Reflection

KEY TAKEAWAYS

Lower-limb venous return depends on the deep and superficial systems, perforators, one-way valves and the calf muscle pump. The great saphenous vein joins the femoral vein at the sapheno-femoral junction (groin); the small saphenous vein joins the popliteal vein at the sapheno-popliteal junction (behind the knee). Varicose veins arise from valvular incompetence → reflux (primary, or secondary to DVT/pelvic obstruction), producing dilated superficial veins and — through venous hypertension — pigmentation, eczema, lipodermatosclerosis and a venous ulcer at the gaiter area (shallow, sloping, relatively painless, pulses present). DVT follows Virchow's triad (stasis, endothelial injury, hypercoagulability), presents as a unilateral swollen tender calf, and threatens pulmonary embolism. Investigate with duplex ultrasound (gold standard for both), the Wells score + D-dimer pathway for DVT, CEAP staging, and always ABPI before compression. Manage varicose veins with conservative care and compression (after ABPI), then endovenous ablation, sclerotherapy or surgery; venous ulcers with graded compression; and DVT with prompt anticoagulation for ≥3 months (IVC filter if anticoagulation contraindicated), with thromboprophylaxis the key to prevention.

REFLECT

Think about a patient with leg swelling you have seen, and ask which system was at fault — was it the chronic, gravity-dependent failure of superficial valves, or the acute, dangerous thrombosis of the deep veins? Reflect on the discipline of always measuring an ABPI before reaching for a compression stocking, and on how easily a mixed arterio-venous ulcer could be harmed by treating it as purely venous. Consider, too, how many in-hospital deaths from pulmonary embolism are preventable: when you next clerk a surgical or immobile patient, will you actively think about their DVT risk and ensure thromboprophylaxis is prescribed? The most powerful venous intervention you will make is often the clot you prevent.