Varicose veins: Varicose veins are abnormally dilated and tortuous veins. They are seen most commonly in the legs, followed by lower esophagus, hemorrhoids in anal region and spermatic cors as varicoceles. In the lower leg, the long saphenous vein is affected. It is more common in females. It is exacerbated by venous stasis resulting from increased pressure due to blocks in drainage. Occupations like surgeons, nurses, that require prolonged standing, pregnancy, pelvic tumors, obesity, chronic constipation and menopausal hormonal changes predispose to varicose veins. Venous valve incompetence of perforator branches leads to backflow of venous blood from the deep to the superficial venous system in the legs, causing superficial varicosities. DVT may also result in retrograde venous flow from deep to the superficial system as the deep veins are blocked, causing varicosities.
Stasis or venous ulcers and stasis dermatitis: Venous ulcers are the most common type of ulcers. They are seen in DVT, venous insufficiency and thrombophlebitis. They are caused due to venous hypertension which leads to venous stasis and inflammation. Endothelial damage and platelet aggregation interfere with local circulation leading to ulcer formation. They may persist for weeks to years. Complications include osteomyelitis, cellulitis, malignancy etc.
| Ulcer type | Features |
| Venous ulcers | More common in women; due to venous hypertension; shallow ulcer located on bony prominences, typically seen over medial malleolus; recurrent ulcers, surrounding edema; associated with stasis dermatitis |
| Arterial ulcers | Caused by ischemia; other associated conditions like CAD, cerebrovascular disease, impotence, claudication; deep ulcers, weak or absent pulses; bruits; located over bony prominences, round or punched out edges with well-demarcated borders; yellow or necrotic base |
| Neuropathic ulcers | Most common foot ulcers; seen in DM, leprosy; due to trauma or prolonged pressure; seen on plantar surface of feet |
| Pressure sores or ulcers | Bedridden patients, due to prolonged pressure causing ischemia and necrosis; located over bony prominences |
Stasis dermatitis consists of skin changes that are seen in patients with chronic venous insufficiency. It is seen bilaterally around the medial malleolus of the foot, in the form of erythematous plaques and eczema like patches, often accompanied by hyperpigmentation. It can progress to ulcer formation, bacterial superinfections and lipodermatosclerosis (panniculitis or inflammation of subcutaneous fat in the lower legs, tapering of legs giving rise to an “inverted champagne bottle” sign). Venous hypertension causes increased hydrostatic pressure in the capillaries causing increased vascular permeability, which leads to transudation of fibrinogen into the tissues, triggering local inflammation. Formation of fibrin cuffs is specific for stasis dermatitis.
Thrombophlebitis and phlebothrombosis: Difference between thrombophlebitis and phlebothrombosis is the presence of inflammation in the former. Virchow triad of venous stasis, hypercoagulability and endothelial damage leads to venous thrombosis. Most common sites are deep veins of the legs, followed by periprostatic plexus, pelvic veins and in veins near infected foci like appendicitis. Thrombophlebitis presents with pain and tenderness along the course of a vein. The inflamed veins can be felt as tender, cord-like structures e.g. Mondor’s disease is thrombophlebitis of superficial veins of the breast and anterior chest wall.
Migratory thrombophlebitis or Trousseau’s syndrome is seen in cancers of the pancreas, prostate, lungs, gastrointestinal tract etc. Multiple venous thrombi involve various areas, from one site to another.
VIII) Vascular Neoplasms: Myxoma is the most common primary tumor of the heart. Most common location is the left atrium. Microscopically, it shows sparse, stellate or spindle-shaped cells with abundant myxoid, mucinous stroma.
Metastases to the heart from primary tumors in the lung, breast, leukemias and lymphomas and malignant melanomas, are the most common cardiac tumors.
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