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      From the Veins to the Heart: A Rare Cause of Varicose Veins

      case-report

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          Abstract

          The presence of pulsating varicous veins is an uncommon finding, generically attributed to right heart failure. The precise causes of this phenomenon have been poorly defined in the literature. The finding of this infrequent condition is important because it may be a sign of major diseases, often not known. Here we described a 75-year-old woman presented to the Angiology Unit for the presence of bilateral pulsatile swelling in her groin and along both lower limbs. A bedside ultrasound examination showed an arterial like pulsating flow both in the superficial and in the deep veins of the lower limbs due to a severe tricuspid regurgitation not previously known.

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          Pulsating varicose veins!! The diagnosis lies in the heart.

          Manzoor Abbas, Mark Hamilton, Mazri Yahya … (2006)
          Right heart failure is associated with increased systemic venous pressure, which can be diagnosed clinically with the findings of elevated jugular venous pressure, pulsatile liver and distinctive cardiac murmurs (precordial systolic). Severe tricuspid regurgitation (TR) has occasionally been known to lead to marked pulsation of varicose veins. We report three cases that were referred to the vascular clinic of Royal Perth Hospital in which the patients involved had unilateral (right leg) varicose veins and chronic venous ulcers. On clinical examination all three patients had pulsations along the course of the varicose long saphenous vein up to the mid calf. The main differential diagnosis was arterio-venous malformation, which was excluded by compression of the sapheno-femoral junction and demonstrating absence of pulsation in the long saphenous vein. A venous duplex scan showed a grossly incompetent sapheno-femoral junction with abnormal wave forms. Two of the cases were managed conservatively with compression dressing. The option of sapheno-femoral junction ligation was reserved in one patient who had unsettling cellulitis and oedema of the lower limb in spite of compression dressing and optimal conservative management. All three patients had improvement in ulcer size at 3-month follow up with compression therapy. This article highlights that in cases of right heart failure the venous pressures can be felt as low as the mid calf level and that can be a cause of the venous ulcers. There should be a high suspicion of right heart failure in patients with late onset venous insufficiency.
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            Peripheral Venous Pulsatility Detected by Doppler Method for Diagnosis of Right Heart Failure

            B Krahenbuhl, A. Restellini, A. Frangos (1984)
            This study shows that peripheral venous flow detected by Doppler ultrasound becomes synchronously pulsatile with heart beats as soon as central venous pressure (CVP) is above 7 mm Hg. CVP was above 7 mm Hg in 13 among 46 patients. Clinical signs of right heart failure were detectable in only 7 of these 13 patients (sensitivity 54%), whereas peripheral venous flow was pulsatile in 12 of them (sensitivity 92%). In 4 patients with a normal CVP, peripheral venous flow was also pulsatile; all of them suffered from valvular heart disease with left ventricle ejection fraction below 60% in 3 of them. The detection of a pulsatile peripheral venous blood flow constitutes an early sign of right heart failure, more sensitive than clinical evaluation, and probably even more than CVP.
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              Pulsating varicose veins

              MR Moawad, SD Blair (1998)
              Article 0 comments Cited 3 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Case Rep Vasc Med
                Journal ID (iso-abbrev): Case Rep Vasc Med
                Journal ID (publisher-id): CRIVAM
                Title: Case Reports in Vascular Medicine
                Publisher: Hindawi Publishing Corporation
                ISSN (Print): 2090-6986
                ISSN (Electronic): 2090-6994
                Publication date (Print): 2015
                Publication date (Electronic): 21 May 2015
                Volume: 2015
                Electronic Location Identifier: 849408
                Affiliations
                1Angiology Unit, Ospedale dell'Angelo, Via Paccagnella 11, 30174 Venezia-Mestre, Italy
                2Department of Cardiology, Ospedale dell'Angelo, Via Paccagnella 11, 30174 Venezia-Mestre, Italy
                3Department of Internal Medicine, Ospedale dell'Angelo, Via Paccagnella 11, 30174 Venezia-Mestre, Italy
                4Department of Vascular Surgery, Ospedale dell'Angelo, Via Paccagnella 11, 30174 Venezia-Mestre, Italy
                Author notes

                Academic Editor: Halvor Naess

                Article
                DOI: 10.1155/2015/849408
                PMC ID: 4454758
                SO-VID: 2b4cf583-e9d2-40c6-ae28-a2c097ff7f12
                Copyright © Copyright © 2015 Michele Dalla Vestra et al.
                License:

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 3 March 2015
                Date revision received : 7 May 2015
                Date accepted : 8 May 2015
                Categories
                Subject: Case Report

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