Surgical Management of Leg Ulcers Associated with Pulsatile Varicose Veins and Tricuspid Regurgitation

Abstract

Design:

Case report.

Setting:

Vascular Surgery Department, Hull Royal Infirmary, UK.

Patients:

A 79-year-old man with a history of right leg ulcer and pulsatile veins.

Investigations and interventions:

Clinical examination revealed findings of tricuspid regurgitation. Investigations included duplex scans, CT scan, arteriography and both trans-thoracic and trans-oesophageal echocardio-graphy. These all proved inconclusive. High sapheno-femoral ligation and stripping of long saphenous vein ligation procedure resulted in healing of his ulcers within six months

Conclusion:

Pulsatile veins in the leg may be due to tricuspid regurgitation or AV malformation. Echocardiogram, duplex scan and angiograms can help to differentiate between the two diagnoses. In this case, the above investigations were misleading and clinical examination here played the key role.