Vascular Surgery , Moore, 4th Edition, pp. Surgery Scientific Principles and Practice , Greenfield, pp. Nine years ago he sustained a gunshot wound to the abdomen which transected his left common iliac vein. Because of other abdominal injuries, the surgeons elected to ligate the ends of the vein after losing 6 units of blood attempting to control the bleeding in the pelvis. He now presents with a swollen left lower extremity and a nonhealing ulcer above the left lateral malleolus.
Exam reveals a left leg swollen twice the size of the right.
There is no pitting edema and no varicose veins. A 4x5 cm elliptical ulcer, 0.3 cm deep, is present on the lateral calf just above the malleolus. Describe four operations for chronic deep venous insufficiency. Examination shows a swollen left leg, slightly warm and somewhat cyanotic in appearance. Initially she was treated with heparin but developed upper gastrointestinal hemorrhage.