A 62-year-old woman has been following-up with you in the clinic for painful ulcers of the lower extremities.

A 62-year-old woman has been following-up with you in the clinic for painful ulcers of the lower extremities. You note that in her history she had moderate swelling in the lower extremities for many years. However, in the past couple years, ulcerations began to appear. History includes fairly well-controlled hypertension, obesity, and depression. Physical examination findings are shown in the provided image. Your preceptor asks you about the process causing her problems. You would best describe the causative process as: Episodic spasm of the small arteries in the legs. Acute bacterial infection spreading up the lymph channels of the legs. Clot formation in deep veins of both legs. Atherosclerosis of large or medium-sized arteries. Chronic venous engorgement secondary to incompetent venous valves.