38 year old female with deep venous thrombosis 14 years ago while on birth control pills. Second DVT shortly after discontinuing anti-coagulation. Hematologic work up showed the patient to have Protein S deficiency. Patient suffered with severe post thrombotic syndrome eventually resulting in venous ulceration 8 years ago. Patient suffered with a chronic ulcer that was eventually healed after venoplasty of the femoral and popliteal veins.
61 year old male, diabetic, developed a lateral right foot ulcer after a pedicure. The posterior tibial artery pulse was palpable.
Recurrent lower extermity DVT should prompt an investigation for venous outflow obstruction. Too often these patients are under treated.
79 year old female with non healing ulcers. Occlusion of all three arteries in the calf.