A Review of Microvascular Dysfunction in Lipedema: Dissociation between Histopathology and Doppler Ultrasound

Lipedema is a chronic subcutaneous adipose tissue disorder characterized by symmetric and disproportionate fat deposition in the lower or upper limbs; associated with pain, tenderness, edema and spontaneous bruising. Histopathological evidence points to chronic low-grade inflammation and microvascular alterations; however, conventional Doppler methods rarely demonstrate hyperemia or inflammatory patterns. Integrate histological and molecular evidences explaining this dissociation and introduce the potential of high-sensitivity Doppler technologies in microcirculation assessment. It is a narrative review of PubMed/MEDLINE-indexed literature, focusing on original studies involving human biopsies and microvascular-interstitial axis analyses in lipedema. The studies selected converge toward a microvascular dysfunction model, characterized by high capillary permeability, endothelial dysfunction, extracellular matrix remodeling, macrophage infiltration and activation of angiogenic pathways; without evidence of arteritis. Only one study evaluated ultra-microangiography in lipedema, with findings not yet reproduced. The lipedema constitutes a chronic functional microangiopathy; this fundamental alteration is not detectable by conventional Doppler. High-sensitivity technologies partially reduce this gap, but remain exploratory tools requiring multicenter validation.