I have been evaluated by a venous specialist, all perforator veins are "perfect." Dermatologist says since I have some spider veins, superficial veins are the cause of lipodermatosclerosis. Can superficial veins cause LDS? If true, what can I do to prevent more damage other than compression stockings?
It may be possible that LDS is associated with only superficial venous insufficiency, in almost all cases, there are incompetent perforator veins that are transmitting the high venous pressures of the deep venous system into the superficial vasculature of the skin.
Often, it is difficult to identify these incompetent perforator veins, especially if the duplex ultrasound examination is only done in the supine position. However, it may be that at rest - even if duplex ultrasound examination is performed while standing - incompetent perforators cannot be identified. Incompetent perforators may only become apparent during walking and activity when the deep venous pressures become quite elevated and only then transmit to the incompetent perforating veins.
Published on Jul 11, 2012
This is hereditary. There is little you can do to prevent the development of superficial/spider veins. Spider veins do not cause LDS. If you have this, you need an ultrasound exam. There is probably underlying reflux.
Published on Jul 11, 2012
You should have your symptomatic, superficial veins treated. Compression stockings prevent swelling and thus reduce symptoms, but do not "prevent" progression of your condition. They (compression stockings) also aid in the prevention of thrombophlebitis.
Published on Jul 11, 2012
It may be advisable to obtain another evaluation by an experienced vein specialist.
Published on Jul 11, 2012
Lipodermatosclerosis (stasis dermatitis) is a usually a sign of severe venous hypertension from any source, although the superficial system of veins is the most common culprit. Spider veins are usually a secondary condition to venous insufficiency rather than the primary cause of stasis dermatitis. There may be a single, common underlying cause of spider veins and lipodermatosclerosis. You mentioned the perforator veins were all OK, how about the great and small saphenous veins, the anterior accessory saphenous vein
and the deep system? I assume these were investigated as well, but you need to make sure they were and that they were also competent (normal).
Published on Jul 11, 2012
Sclerotherapy is probably the answer.
Published on Jul 11, 2012
Have your spider veins treated by a vein doctor
Published on Jul 11, 2012
Did the dermatologist you consulted with mention sclerotherapy as an option? You might want to ask about that modality.
Published on Jul 11, 2012
Venous insufficiency of the superficial veins can cause these symptoms. Sometimes a venous ablation procedure can help. See a vein specialist for an opinion.
Published on Jul 11, 2012
Lipodermatosclerosis is caused by ambulatory venous hypertension. Spider veins do not by themselves cause that. See a phlebologist certified by the American Board of Phlebology to have another duplex ultrasound.
Published on Jul 11, 2012
Get the veins treated. Sclerotherapy would be the preferred method for what you describe.
Published on Jul 11, 2012
If you have lipodermatosclerosis then you are at least a level 4/6 CEAP vein classification, with 6 being the worst. You should have a full evaluation of the valves in your superficial system to look for reflux and, if present, then undergo closure of the veins to reduce the venous hypertension. If no reflux, then you need compression hose.
Published on Jul 11, 2012