Iliac vein stenting
Sachinder Singh Hans, Alexander D Shepard, Mitchell R Weaver, Paul G Bove, Graham W Long in Endovascular and Open Vascular Reconstruction, 2017
A 67-year-old woman presented with a long-standing history of CVI of the bilateral lower extremities, including pain and swelling. Her left lower extremity was more symptomatic. The remainder of her clinical history was unremarkable, except for obstructive sleep apnea. Examination revealed an obese lady with bilateral lower extremity edema, worse on the left. There was bilateral lipodermatosclerosis involving the lower legs. Workup included venous duplex US of the lower extremities, air plethysmography, and CTV that confirmed luminal compromise of the femoro-ilio-caval segment, which was likely post-thrombotic in nature. Calf pump function was also compromised. Given her lack of improvement with conservative therapy, she was taken to the operating room for a left femoro-ilio-caval venogram, IVUS interrogation, and possible angioplasty and stenting.
Stasis Dermatitis
Donald Rudikoff, Steven R. Cohen, Noah Scheinfeld in Atopic Dermatitis and Eczematous Disorders, 2014
Clinically, lipodermatosclerosis presents as firm induration of the lower leg, with a taut, bound-down appearance of the overlying skin. In the acute inflammatory phase, lipodermatosclerosis is accompanied by exquisitely tender erythema, making simple palpation of the affected leg extremely painful for the patient. Chronic lipodermatosclerosis results in the classic ‘inverted champagne bottle’ appearance, with the scarred, bound-down, hyperpigmented lower leg giving way to the edematous, nonsclerotic, superior portion of the affected leg (Kirsner et al. 1993) (Fig 17.3). The painful, acute phase of lipodermatosclerosis is frequently misdiagnosed as cellulitis or erysipelas, and, even for the experienced dermatologist, it may be difficult to distinguish the two with certainty (Reich-Schupke et al. 2009). One clinical clue is that cellulitis is most often unilateral; only rarely are pathogenic bacteria able to breach the defenses of both legs at once. Therefore, many hospital consultations for ‘bilateral cellulitis’ are actually for exacerbations of lipodermatosclerosis.
Venous thromboembolic disease in older adults
Wilbert S. Aronow, Jerome L. Fleg, Michael W. Rich in Tresch and Aronow’s Cardiovascular Disease in the Elderly, 2019
In about half of DVT patients, the clot recanalizes over time without further signs or symptoms. Post-thrombotic syndrome (PTS) is a chronic condition that develops in 20%–50%. It is defined by edema, skin changes, varicosities, leg ulcers, pain, and heaviness, often resulting in a negative impact on quality of life (10). The skin discoloration is described as “brawny” due to iron staining from red cell stasis. Tenderness of the medial lower leg is labeled as “lipodermatosclerosis.” Venous stasis ulcers may develop which heal slowly and often recur. PTS is a clinical diagnosis that can be confused with recurrent thrombosis. Elastic compression stockings are often applied to reduce edema and treat the symptoms of an acute DVT, however, they have not reduced the incidence of the PTS (11).
An appraisal of vascular endothelial growth factor (VEGF): the dynamic molecule of wound healing and its current clinical applications
Published in Growth Factors, 2022
Aakansha Giri Goswami, Somprakas Basu, Farhanul Huda, Jayanti Pant, Amrita Ghosh Kar, Tuhina Banerjee, Vijay Kumar Shukla
Herouy et al. (2009) suggested that although both mRNA and protein levels VEGF is elevated in lipodermatosclerosis, it is the imbalance between the ligand-receptor system for VEGF and angiopoietin, which disturbs the dynamic balance of angiogenesis and its breakdown, thus, favoring an enhanced antiangiogenic process in lipodermatosclerosis. A clear understanding of the above process can help us develop a therapeutic tool by targeting the antiangiogenic activity in cases of chronic venous ulcers. It has been indicated that the raised VEGF levels in patients with venous ulcers showed significant reduction after treatment, and correlated well with the reduction in ulcer size (Murphy et al. 2002). Nevertheless, the therapeutic capabilities of VEGF in the treatment of chronic venous disease are still being explored and the final word on its early diagnostic benefit or the therapeutic pharmacological inhibition is yet to be written.
Leg ulceration with histological features of pseudoxanthoma elasticum
Published in Baylor University Medical Center Proceedings, 2021
Usman Asad, Sheevam Shah, Palak Parekh
Pseudoxanthoma elasticum (PXE) is an inherited connective tissue disorder with extensive degeneration and calcification of elastic tissue, primarily in the skin, eyes, and vasculature. PXE presents as characteristic yellowish papules and plaques and retinal angioid streaks.1 Lipodermatosclerosis refers to skin induration of the lower extremities secondary to venous stasis and is often seen in patients preceding venous ulceration, which is characterized by total loss of the epidermis and partial loss of matrix structures in the upper dermis.2 In this report, we present a case of a woman who presented with ulceration and lipodermatosclerosis alongside histological features of PXE.
US budget impact of increased payer adoption of the Flexitouch advanced pneumatic compression device in lymphedema patients with advanced chronic venous insufficiency and multiple infections
Published in Journal of Medical Economics, 2018
Adam Cohen, Julia A. Gaebler, Jessica Izhakoff, Laura Gullett, Timothy Niecko, Thomas O’Donnell
The clinical literature suggests that certain sub-populations have increased risk of LE morbidity7. Patients with phlebolymphedema, a vascular condition resulting from the combined effects of LE and chronic venous insufficiency (CVI), are known to be more difficult to manage than those with LE alone, due to the involvement of the two vascular systems8. These patients often experience significant edema, lipodermatosclerosis, and skin ulceration7. Infection, typically erysipelas, cellulitis, or lymphangitis, is also a common complication of LE9. Patients who experience one episode of cellulitis have a relatively high likelihood of recurrence10.
Related Knowledge Centers
- Blood Pressure
- Body Weight
- Epidermis
- Inflammation
- Obesity
- Panniculitis
- Connective Tissue
- Skin
- Pathogenesis
- Skin Condition