1. Ultrasonography of Skin Changes in Legs with Chronic Venous Disease
A. Caggiati 
European Journal of Vascular and Endovascular Surgery 
Volume 52, Issue 4, Pages (October 2016)
DOI: /j.ejvs
Copyright © 2016 European Society for Vascular Surgery Terms and Conditions

2. Figure 1
Normal skin. (A) 12 MHz sonography. (B, C) Light microscopy (hematoxylin and eosin, original magnification 20×). E = epidermis; PD = papillary dermis; RD = reticular dermis; MF = muscular fascia; DHJ = dermo-hypodermic junction.
European Journal of Vascular and Endovascular Surgery  , DOI: ( /j.ejvs )
Copyright © 2016 European Society for Vascular Surgery Terms and Conditions

3. Figure 2
Inflammation in apparently normal skin of C2 legs. (A) Marked increase of dermal echogenicity in the skin overlying a varicose vein. Note the absence of the subendothelial low echogenic band. (B) A hyperechogenic halo extending from the dermis to the subcutaneous layer surrounds a varicose vein. Inset: related histology demonstrating skin infiltration (hematoxylin and eosin, original magnification 20×). (C) Dermal hyperechogenicity in correspondence of a cluster of varicose veins extending into the dermis (arrow). (D) Dermal edema (arrow) in correspondence of a varicose vein.
European Journal of Vascular and Endovascular Surgery  , DOI: ( /j.ejvs )
Copyright © 2016 European Society for Vascular Surgery Terms and Conditions

4. Figure 3
Dermal edema. (A) Only the subendothelial low echogenic band appears anechoic and thickened. Note the absence of echoes from the space underlying the epidermis. Arrow: the dermo-hypodermic junction. (B) Hypoechogenicity and rarefaction of pixels in the whole dermis. Arrow: the dermo-hypodermic junction. (C) Histology demonstrates enlarged interstitial spaces (hematoxylin and eosin, original magnification 10×).
European Journal of Vascular and Endovascular Surgery  , DOI: ( /j.ejvs )
Copyright © 2016 European Society for Vascular Surgery Terms and Conditions

5. Figure 4
Skin sonography in swollen legs. (A) and (B) Uniform thickening of the subcutaneous layer (SCL). (C) and (D) SCL thickening resulting from anechoic lacunae of different size, extension, and orientation. Dermal edema (arrow) is present only in (B) and (D).
European Journal of Vascular and Endovascular Surgery  , DOI: ( /j.ejvs )
Copyright © 2016 European Society for Vascular Surgery Terms and Conditions

6. Figure 5
Skin inflammation. Skin sonography in eczematous skin, compared with the contralateral normal skin.
European Journal of Vascular and Endovascular Surgery  , DOI: ( /j.ejvs )
Copyright © 2016 European Society for Vascular Surgery Terms and Conditions

7. Figure 6
Skin sonography of lipodermatosclerotic skin. (A) Scleroedematous pattern. Hyperechogenicity (*) of either the dermis and the thickened subcutaneous layer (SCL) with disappearing of the dermo-hypodermic junction. (B) Scleroedematous pattern. Note the presence of anechoic lacunae (arrow) and thickening of the dermis. (C) Fibrosclerotic pattern. Narrowing and hyperechogenicity of the SCL, with disappearing of the dermo-hypodermic junction. Subcutaneous fibrous trabeculae are not recognizable. Inset: fibrous proliferation and rarefaction of fat lobuli (hematoxylin and eosin, original magnification 10×). (D) The echolucent layer abruptly disappears in correspondence of an area of epidermal loss (arrow). (E) Thickening of the epidermis (arrow) overlying an edematous papillary layer (*).
European Journal of Vascular and Endovascular Surgery  , DOI: ( /j.ejvs )
Copyright © 2016 European Society for Vascular Surgery Terms and Conditions

8. Figure 7
NP, 48-year-old male. A wide hypoechogenic area (*) in the subcutaneous layer (A) which reduced after 7 (B) and 14 (C) days of compression.
European Journal of Vascular and Endovascular Surgery  , DOI: ( /j.ejvs )
Copyright © 2016 European Society for Vascular Surgery Terms and Conditions

9. Figure 8
CF, 78-year-old female. (A) Subcutaneous layer (SCL) hyperechogenicity with wide and confluencing anechoic lacunae (*). The patient refused bandaging. (B) 7 days later, a skin fissuration occurred (arrow) and the patient accepted bandaging. (C) After 2 weeks of compression, the SCL was more compact thanks to a marked reduction of the anechoic folds. A small dysepithelialized area was still present. (D) 6 weeks later, the ulcer healed with complete re-epithelialization.
European Journal of Vascular and Endovascular Surgery  , DOI: ( /j.ejvs )
Copyright © 2016 European Society for Vascular Surgery Terms and Conditions