What is Lipdermatosclerosis?
Lipodermatosclerosis (LDS) is a skin and connective tissue disorder of the lower extremity which usually causes a brownish discoloration on the inner aspect of the ankle. LDS is the result of inflammation of the layer of fat under the epidermis; thus the term lipo (fat)-dermato (skin)-sclerosis (abnormal hardening of body tissue).
Patients with venous disease can present with different levels of severity. LDS is usually a sign of advanced venous disease. As venous disease severity increases, so does the blood pressure in the veins (venous hypertension). These high vein pressures can “push” molecules that function as the body’s natural defense mechanisms out of the circulation and into tissues around the lower leg and ankle causing chronic inflammation and tissue damage. People with more severe LDS have tapering of their legs above the ankles, forming a constricting band resembling an inverted champagne bottle.
How is Lipodermatosclerosis Diagnosed?
Proper diagnosis begins by taking a history from patients asking questions related to previous episodes of deep vein thrombosis (DVT), and/or any family history of vein disorders. This together with a physical examination helps guide the next step. Using duplex ultrasound imaging, doctors can visualize the anatomy of the deep, superficial and perforating venous systems and their function.
How is Lipodermatosclerosis Treated?
As for treatment of LDS, we begin with conservative management reducing vein pressure with leg elevation and elastic compression stockings. However, most often a catheter-based treatment will be required to lower the venous pressure further. The most common cause of elevated vein pressure is from backflow of blood (reflux) in the saphenous vein. Saphenous vein reflux is treated with endovenous ablation technology which can be performed under local anesthesia in a vascular surgeon’s office. The second most common cause of elevated vein pressure is deep vein obstruction (scarring) resulting from previous deep vein thrombosis (blood clots). In these cases the obstructed veins can be dilated open with endovenous balloons followed placement of a stent to maintain good blood flow. These procedures can also done in the office of a vascular surgeon using mild sedation.
By controlling the elevated vein pressures causing LDS, patients will typically not progress to the most advanced form of vein disease, i.e. – a large ulcer on the medial ankle.
Which Treatment is Right for Me?
Doctor Almeida will choose the least invasive and best technique to treat your lipodermatosclerosis at the source with minimal healing time. Factors such as your overall health, medical history, personal preference and vascular condition will be assessed to determine the best course of treatment.
Each treatment has its set of possible risks and side effects, which Dr. Almeida will discuss with you prior to the procedure.
Contact Miami Vein Center to schedule a consultation with Dr. Almeida and find out the cause and treatment options.