Skin color changes are common with vascular disease. In chronic arterial insufficiency, the affected extremity is cool and pale. In chronic venous insufficiency, the extremity is warmer than normal. The leg becomes erythematous, and erosions produced by excoriation result. With chronic insufficiency, stasis changes produce increased pigmentation, swelling, and an ''aching'' or ''heaviness'' in the legs. These changes characteristically occur in the lower third of the extremity and are more prominent medially. When venous insufficiency occurs, edema of dependent areas results.
Patients with acute deep vein thrombosis have secondary inflammation of the tissue surrounding the vein. This produces signs of inflammation: warmth, redness, and fever. Swelling is the most reliable symptom and sign associated with venous obstruction. This finding is indicative of severe deep vein obstruction because the superficial veins of the lower extremity carry only 20% of the total drainage and are not associated with swelling. The extremities should be compared, and a difference in circumference of 2 cm at the ankle or midcalf should be considered significant.
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