Chronic Venous Insufficiency and Varicose Veins

A 52-year-old receptionist presents with an ulcer on her ankle of 1 year's duration. Narcotic analgesics once or twice a day and leg elevation reduce the pain. She has not had diabetes and does not smoke. Physical examination reveals an ulcer above the medial malleolus, with a clean bed of granulation and surrounded by hyperpigmented skin. Pedal pulses are easily palpable. How should she be evaluated and treated? A 52-year-old woman presents with an ulcer on her ankle of 1 year's duration. Physical examination reveals an ulcer above the medial malleolus, with a clean bed of granulation and surrounded by hyperpigmented skin. How should she be evaluated and treated? Foreword This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the authors' clinical recommendations. Stage A 52-year-old receptionist presents with an ulcer on her ankle that has persisted for a year. The use of narcotic analgesics once or twice a day and elevation of the leg reduce the pain. She does not have a history of diabetes and does not smoke. Physical examination reveals an ulcer, approximately 5 cm in diameter, above the medial malleolus. The ulcer has a clean bed of granulation and is surrounded by hyperpigmented skin. Pedal pulses are easily palpable. How should she be evaluated and treated? The Clinical Problem Chronic venous insufficiency is associated with a wide clinical spectrum . . .