Introduction: Lipodermatosclerosis is a symptom of severe venous insufficiency, the diagnosis of which is based on the clinical picture. Although the histopathology of the skin and the subcutaneous tissue allows for the most reliable diagnosis, it is not recommended due to healing disorders. Aim: The aim of this study was to assess the usefulness of high-frequency ultrasound in the diagnosis of lipodermatosclerosis. Materials and methods: The study included 10 patients with lipodermatosclerosis who underwent Duplex Doppler ultrasound of lower limb veins, high-frequency ultrasound of the tibial skin, and radiography of the lower leg, all of which were analyzed in correlation with clinical symptoms. Results: The study group included 9 women and 1 man aged 39–81 years. Manifestations of lipodermatosclerosis were detected in 14 limbs. High-frequency ultrasound showed that the mean dermis thickness at the affected sites was 2.63 mm, and was significantly thicker compared to healthy skin (1.45 mm) (p = 0.00002). Higher echogenicity was detected in the affected body regions in 85.7% of cases for the skin and 92.9% of cases for the subcutaneous tissue. Subcutaneous and vascular wall calcifications were detected in 92.9% and 78.6% of cases, respectively. Fibrosis was observed in all limbs, and compression sonoelastography showed that the compliance of the subcutaneous tissue was lower than that of muscles. The border between the skin and the subcutaneous tissue was blurred in 57.1% of cases. Radiography revealed thickening of the affected skin regions in all limbs, with calcifications detected in 85.7% of cases. A blurred border between the skin and the subcutaneous tissue was observed in 35.7% of limbs. Conclusion: High-frequency ultrasonography of the skin and the subcutaneous tissue in the lower legs supported with radiological findings is highly useful in the diagnosis of lipodermatosclerosis.

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Search was performed using combination of keywords : ''intravenous drug abuse'', ''pseudo-aneurysm'', ''limb ischaemia'' , ''intra-arterial injection'', "artery ligation" and "bypass surgery". Results: A total of 21 articles were identified covering a total of 529 patients. Selected articles were case reports (n ¼ 5), case series (n ¼ 6) or retrospective studies (n ¼10). Surgical management consisted of either femoral artery ligation (FAL) and local debridement in 414 cases (78%) or local debridement plus primary revascularisation (LDPR) using Autologous vein/artery graft 38.3%, cryopreserved 1.6% or synthetic graft 60.1% in 115 cases (22%). LDPR group was associated with higher amputation rate 11% compared to FAL group 6%. Mortality rate is 2.6% in LDPR group compared to 0.7% in FAL. However, claudication incidence was higher in FAP 23.4% compared to 7.8% in the LDPR. In the LDPR group, using of vein/artery graft or Patch was associated with the lowest amputation rate (4%) and claudication incidence (2%) with mortality rate of 2%. Conclusion: Primary femoral artery ligation remains the first and safest option for management of intravenous drug abusers' groin pseudoaneurysms. However, in selected patients with an adequate autologous conduit, primary revascularization has a better outcome in term of amputation and claudication rate.