65 year old male presented with a right lower extremity venous ulcer. During workup, the patient was found to have extensive incompetence of the superficial and deep venous systems. This prompted evaluation for venous outflow obstruction. CT Venography showed compression of the proximal right external iliac vein at the bifurcation of the right common iliac artery between the external and internal iliac arteries. Treatment of the venous outflow obstruction resulted in near ulcer healing in 1 month. After correction of the superficial venous disease, the ulcer completely healed. Extensive superficial and deep incompetence should prompt evaluation of the venous outflow in the pelvis.
Ultrasound of Incompetent SaphenoFemoral Junction Valve
64 year old male, type 1 diabetes, with a prior femoral to politeal bypass graft and a subsequent poplileal to tibial bypass graft.
Recurrent lower extermity DVT should prompt an investigation for venous outflow obstruction. Too often these patients are under treated.