Clinical presentation and
Medical history
The medical history concentrates on familial or personal
diagnosis of venous leg ulcer risk factors, vascular risks (varicose veins, symptoms of
CVI, deep vein thrombosis, hypertension, arteriopathies,
claudication), lifestyle habits (occupation, sedentary
About 90 % of leg ulcers develop as a result of venous
lifestyle, little exercise etc.), medication use, alcohol and
hypertension secondary to severe chronic venous insuffi-
tobacco consumption, type of onset and development of
ciency. About 6 % of venous leg ulcers are attributable
the ulcer (e.g. after injury or blunt trauma), but also pre-
vious local or systemic treatments.
to reduced peripheral arterial blood supply and about
4 % to specific skin diseases. An exact diagnosis is Localization and form of the ulcers
therefore essential. This requires taking a detailed med-
Venous ulcers preferentially develop at the ankle
ical history, a clinical and instrumental examination and
(Bisgaard region) and allow a “prima vista” diagnosis. In
differential diagnostic procedures to rule out non-venous
about 20 % of cases, however, they also develop at other
sites on the lower leg, a situation which always requires
etiopathological factors.
differential diagnostic clarification. The shape and size of
the venous ulcer are variable, and the ulceration can
spread to cover the entire gaiter area of the lower leg.
1) Typical localization of venous
ulcers, with postthrombotic ulcer
as an example
2) Ulcerations resembling gaiters
enclosing the lower leg
3) and 4) mixed venous leg ulcer
due to CVI and pAOD
1 2
3 4
Clinical presentation and diagnosis [16.17]
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