Venous insufficiency: The Daily PANCE Blueprint

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Venous insufficiency: The Daily PANCE Blueprint

A 60-year-old female with a history of a prior left lower extremity DVT presents to the clinic complaining of dull pain and swelling of her left leg for the past year. The pain is exacerbated by prolonged standing. On physical exam, you note edema of the left leg with brownish discoloration. What is the best initial diagnostic test for this patient?

A. Venous duplex US
B. CT with contrast
C. D-dimer
D. CTA chest
E. ABI

Answer and topic summary

The answer is A. Venous duplex US

Chronic venous insufficiency is defined by disturbances in the venous outflow. Risk factors include advancing age, family history, prolonged standing, smoking, sedentary lifestyle, lower extremity trauma, prior deep venous thrombosis, and pregnancy. Clinical features vary but can include: spider veins, heavy/discomfort in legs, varicose veins, leg edema, pigmentation, atrophie blanche, and venous ulceration. Venous duplex ultrasonography is the most common diagnostic tool. Management initially includes compression stockings and risk modifications (i.e., exercise, stop smoking, etc).

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Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint Cardiology ⇒ Vascular Disease (PEARLS) ⇒ Venous insufficiency (ReelDx)

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