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Studies of patients with lipodermatosclerosis have demonstrated significantly decreased concentrations of cutaneous oxygen associated with decreased capillary density. Capillaries are virtually absent in areas of fibrotic scars, leading to a condition known as atrophie blanche or livedoid vasculopathy.
Livedo reticularis is a common skin finding consisting of a mottled reticulated vascular pattern that appears as a lace-like purplish discoloration of the skin. [1] The discoloration is caused by reduction in blood flow through the arterioles that supply the cutaneous capillaries, resulting in deoxygenated blood showing as blue discoloration ().
The pain can be described as throbbing and can worsen with weight-bearing, prompting one to bear more weight with the unaffected leg. [ 21 ] [ 24 ] Additional signs and symptoms include tenderness, pitting edema ( see image ), dilation of surface veins, warmth, discoloration, a "pulling sensation", and even cyanosis (a blue or purplish ...
After a trial of the best medical treatment outlined above, if symptoms persist, patients may be referred to a vascular or endovascular surgeon. The benefit of revascularization is thought to correspond to the severity of ischemia and the presence of other risk factors for limb loss, such as wound and infection severity. [67]
The prevention of episodes of SCLS has involved two approaches. The earliest was advocated by the Mayo Clinic, and it recommended treatment with high doses of beta agonists such as terbutaline, phosphodiesterase-inhibitor theophylline, and leukotriene-receptor antagonists montelukast sodium. [10] [12]
Both neurogenic claudication and vascular claudication manifest as leg pain with walking, but several key features help distinguish between these conditions. [7] In contrast to NC, vascular claudication does not vary with changes in posture. [9] Patients with vascular claudication may experience relief with standing, which may provoke symptoms ...
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Rest pain is a continuous burning pain of the lower leg or feet. It begins, or is aggravated, after reclining or elevating the limb and is relieved by sitting or standing. It is more severe than intermittent claudication, which is also a pain in the legs from arterial insufficiency. [citation needed]
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