A 35-year-old woman with a nonhealing ulcer on the medial ankle and surrounding skin pigmentation consistent with lipodermatosclerosis. Best diagnostic test?

A 35-year-old woman with a nonhealing ulcer on the medial ankle and surrounding skin pigmentation consistent with lipodermatosclerosis. Best diagnostic test?

• A. Venous duplex US
• B. Ankle-brachial index
• C. Skin biopsy
• D. Arterial Doppler

Answer: (A)

In this scenario the problem is chronic venous insufficiency causing a venous ulcer. Lipodermatosclerosis and a medial ankle location strongly point to venous hypertension as the driver of nonhealing ulcers. The best test to confirm venous reflux and map the faulty venous segments is venous duplex ultrasound. It combines compression ultrasound with color flow to show valvular incompetence, reflux in the superficial or deep venous system, and incompetent perforators, which directly informs treatment options such as compression therapy or endovenous ablation or surgery. An ankle-brachial index Measures arterial perfusion, not venous reflux, and can be misleadingly normal in venous ulcers. Arterial Doppler serves to assess arteries rather than veins. Skin biopsy is not needed for typical venous ulcers and is reserved for atypical or suspicious lesions.

In this scenario the problem is chronic venous insufficiency causing a venous ulcer. Lipodermatosclerosis and a medial ankle location strongly point to venous hypertension as the driver of nonhealing ulcers. The best test to confirm venous reflux and map the faulty venous segments is venous duplex ultrasound. It combines compression ultrasound with color flow to show valvular incompetence, reflux in the superficial or deep venous system, and incompetent perforators, which directly informs treatment options such as compression therapy or endovenous ablation or surgery.

An ankle-brachial index Measures arterial perfusion, not venous reflux, and can be misleadingly normal in venous ulcers. Arterial Doppler serves to assess arteries rather than veins. Skin biopsy is not needed for typical venous ulcers and is reserved for atypical or suspicious lesions.