Surgical management of leg ulcers associated with pulsatile varicose veinsand tricuspid regurgitation

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, ar teriography and both trans-thoracic and trans-oesophageal echocardiography. These all proved inconclusive. High saphenofemoral 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 regurgitatio n or AV malformation. Echocardiogram, duplex scan and angiograms can help t o differentiate between the two diagnoses. In this case, the above investig ations were misleading and clinical examination here played the key role.