Question
A 34-year-old woman, gravida 4, para 3, comes to the physician because of left ankle swelling for 2 months. She noted that the swelling is present throughout the day and decreases when she goes to sleep. One year ago, she had an episode of deep venous thrombosis after the delivery of her third child. Her prepregnancy BMI was 34 kg/m2. Examination shows distended, tortuous veins in the legs bilaterally and pitting edema of the left ankle. There are erythematous scaling patches on the medial side of the left ankle. Duplex ultrasonography is performed. Which of the following directions of blood flow would most likely confirm the diagnosis?
| A. |
Popliteal vein to small saphenous vein
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| B. |
Anterior tibial vein to popliteal vein
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| C. |
Great saphenous vein to femoral vein
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| D. |
Femoral vein to external iliac vein
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Show Answer
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Correct Answer � A
Explanation
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Answer A) Popliteal vein to small saphenous vein
Explanation: Distended and tortuous veins in both legs, ankle edema, and skin changes on the medial ankle indicate chronic venous disease.
Popliteal vein to small saphenous vein
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Venous blood flowing from the deep popliteal vein to the superficial small saphenous vein indicates retrograde blood flow and confirms the diagnosis of chronic venous disease.
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Normally, the small saphenous vein would arise from the dorsal venous arch and drain into the popliteal vein at the saphenopopliteal junction.
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In a patient with chronic venous disease, however, incompetence of the venous valves caused by elevated venous pressure (e.g., due to pregnancy, increased BMI, prior thrombosis) leads to blood reflux from deep into superficial veins.
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This results in the formation of varicose veins, and ultimately edema and skin changes (e.g., stasis dermatitis), as seen in this patient. First-line treatment consists of conservative measures such as leg elevation, compression therapy, and application of topical dermatologic agents.
