Five Venous Cases: From Glue Reactions to Ulcer Healing
Five Cases, One Afternoon
This interactive session moved through superficial, deep, pelvic, wound and combined venous disease, with faculty putting questions to medical students, residents and fellows at every step.
The Cases
- Cyanoacrylate hypersensitivity after great saphenous closure, appearing on day six as pain and erythema, the picture that often gets labelled cellulitis in the emergency department. Ask about adhesive allergies before choosing glue.
- Iliocaval thrombosis in a man with metastatic rectal cancer and an IVC filter. The rectal bleeding was controlled endoscopically first, so anticoagulation was possible before thrombectomy and stenting.
- Nutcracker and May-Thurner together. The iliac vein was stented first as the less invasive step, and the left renal vein was later transposed robotically with a urologist.
- Venous ulcers, where compression and wound care heal most limbs but early ablation shortens healing and lowers recurrence in the randomized trials reviewed.
- Post-thrombotic swelling relieved by small saphenous ablation plus a pneumatic compression pump.
Recurring Lessons
Scan standing rather than supine. Look higher when one leg swells without explanation. Swollen toes point to the lymphatic system rather than the veins.
