L. Abbott, K. Parsi
Livedo vasculopathy (LV) is a thrombotic condition pri- marily affecting the cutaneous microcirculation. This con- dition typically presents with reticulate pigmentation localised to the lower legs and interspersed with stellate scars of atrophie blanche. Patients generally give a history of recurrent and sometimes seasonal painful ulceration. The aetiology of LV is unknown, although the disease is associated with underlying thrombophilias, disorders of ﬁbrinolysis, connective tissue disorders, paraproteinemias and infections. Management efforts to date have largely focused on the underlying hypercoagulable state and not the affected ves- sels. We present four patients who did not respond to anti- coagulant and other conventional therapies. Associated venous incompetence was identiﬁed on duplex mapping and vessels deemed to be involved in the process of vascu- lopathy were treated with ablative methods. The treatment aimed to interrupt the cycle of recurrent ulceration and to induce clinical improvement.
Thrombotic occlusion of sub-dermal and dermal veins is the primary pathology in LV. We postulated that the abla- tion of the affected vessels and treatment of the localised venous hypertension may offer an opportunity to improve the clinical outcome and quality of life for patients with LV.