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. A venogram shows thrombus in the vena cava to within 3 cm of the renal veins. He is a left-handed barber. Doppler examination suggests axillary vein occlusion. Venogram confirms this.