Venous insufficiency and ulcers Quiz: Ace Your Exams
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A 62-year-old man with coronary artery disease and hypertension presents to the clinic for evaluation of bilateral lower leg swelling. The swelling is better in the morning and worsens as the day progresses. The patient’s legs feel “heavy,” and he has noticed skin discoloration recently. He is unsure exactly when the symptoms started. Temperature is 37.0°C (98.6°C), heart rate is 84/min, respiratory rate is 12/min, blood pressure is 132/78 mmHg and oxygen saturation is 100% on room air. On physical examination, there is tense, bilateral edema of both lower legs with overlying brown discoloration of the skin. Multiple spider-like veins and tortuous veins are present. Both legs are warm to the touch. 2+ dorsalis pedis and posterior tibial pulses are noted bilaterally. What is the most likely mechanism of this patient’s skin discoloration?
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