Venous stasis

Background

• Decreased rate of return of venous blood flow to heart (most commonly in lower extremities)
• Leads to characteristic vascular and skin changes
• Common in individuals with chronic vascular disease, diabetes, obesity, smoking history, prolonged immobility

Clinical Features

Venous stasis dermatitis

• Skin becomes darker/purple, dry, tight, and hairless
  • In severe cases may see venous insufficiency ulcers
• Patients may complain of leg heaviness, fatigue, or cramping
• Unlike cellulitis erythema from venous stasis tends to change with dependent positioning of the affected limb

Long term venous stasis skin changes

Differential Diagnosis

• Cellulitis
• Deep venous thrombosis
• Critical limb ischemia
• Peripheral artery disease
• Ruptured Baker cyst
• Superficial thrombophlebitis
• Necrotizing fasciitis
• Compartment syndrome
• Complex regional pain syndrome

Evaluation

• Duplex scan if suspicion for DVT

Management

• Limb elevation, compression, and increased exercise

Disposition

• Discharge