Red or purple discoloration of the skin with decrease of skin temperature are
signs of postthrombotic syndrome or chronic venous insufficiency (class 4 CEAP
classification). It is consistent with history of DVT and, by the way, it is
not a celulitis(should be worm.
There are some studies made in early 80th mostly in Europe showing significant
decrease of arterial flow in legs with chronic venous insufficiency. I can
mail you the reference, if you would like.
Development of venous thrombosis might cause prolong vasoconstriction
(phlegmosia alba). When it happen in the limb with already CVI, decrease of
the skin temperature is the only sign.
All these should not exclude careful duplex arterial examination to r/o silent
arterial disease.
Very nice case, Thanks

-----Original Message-----
From: Don Thompson <[log in to unmask]>
To: [log in to unmask] <[log in to unmask]>
Date: Tuesday, September 07, 1999 8:08 PM
Subject: arterial vs venous


>I had a very interesting study today and would like to pick all you
>brains for your opinions.
>I had a 78 year old man in for lower arterial testing. He had past
>history of DVT left pop-post tib found first in May and re-imaged in
>July with some recanalization noted.
>Has been on home therapy for DVT.  His nephrologist ordered segmental
>pressures with doppler to I guess rule out occuded vessels.  His left
>leg had 2-3+ edema was red from foot to mid shin.  But also his left leg
>was very cool to touch from mid shin down, warm from there up.  He
>stated he had no real pain or tenderness.
>Testing findings were normal right leg except that up thigh and calf
>cuff could not be totally occluded.  Left extremity thigh had all
>pressure within normal limits also, but wave forms were diminished, and
>even had toe pressures noted.  Left ankle could not be totally occluded
>either.  Otherwise the  study would be considered normal by  most
>standards, except for the fact the leg was swollen, cool, and red.
>Consulted senior retired vascular surgeon and he agreed with the fast
>that the DVT should be evaluated again...The coolness of the leg was our
>biggest discussion....
>I am ready for all your opinions....and very interested in them too.
>
>thanks,
>deb thompson, cvtech, HVCH


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