An 81-year old male sustained a dog bite to his right lateral calf. Despite antibiotics, the patient continued to have leg swelling, severe itching and a chronic wound. He was evaluated at the Wound Center, at which time a diagnosis of chronic venous insufficiency was made and a venous reflux exam was recommended.
The patient was scanned using Intersocietal Accreditation Commission Vascular Testing venous reflux protocol. Imaging was directed to the area of concern at the lateral calf. A 1.1 mm vein branch off the proximal calf great saphenous vein (GSV) was identified under the itching/trauma area with venous reflux.
Venous reflux exam findings identified significant venous reflux from the right saphenofemoral junction through the distal GSV and vein branches. An elective right GSV endothermal venous ablation and stab phlebectomy were performed. The patient returned per protocol on post-operative day two. He reported no pain and complete resolution of the itching. Physical exam demonstrated marked improvement of the excoriated area. Surveillance duplex revealed no evidence of an endovenous heat induced thrombosis.
Venous stasis dermatitis occurs when there is inflammation of the skin caused by chronic venous insufficiency. In the early stages, symptoms include swelling at the ankles, hyperpigmentation, dryness and itching. The development of stasis dermatitis can be precipitated by trauma, thereby unmasking underlying chronic venous insufficiency. Stasis dermatitis in this patient resolved because we treated the cause: chronic venous insufficiency.
Jessica Kralec, Technical Director, RDMS RVT RPhS, Vein Center at GBMC Health Partners