TITLE:
A Review of Microvascular Dysfunction in Lipedema: Dissociation between Histopathology and Doppler Ultrasound
AUTHORS:
Deise Vargas, Thais Oliveira Foureaux, Maria Gemma Sempere Campello, María Álvarez González, João Antonio Correa, Walkiria Hueb Bernardi, Christina Ignes Sabbagh Bahia, Adriana Ferraz de Vasconcelos, Adriana de Carvalho e Sousa e Silva, Dayana de Ornelas Andrade, Leandro Scaléa Lechuga Baena, Alan Werneck Ramos, Gabriel Vieira Lins de Oliveira Lima, Clarisse Sales Gurgel de Azevedo, Thacira Dantas Almeida Ramos, Marcelo Volpatto Ortiz, Lucas Dourado de Oliveira Nogueira, Sabrina de Carvalho Camacho Sanchez, Alexandre Sacchetti Bezerra, Alexandre Campos Moraes Amato, Anderson Nadiak Bueno
KEYWORDS:
Lipedema, Microcirculation, Endothelial Dysfunction, Capillary Permeability, Microvascular Doppler, Pathophysiology
JOURNAL NAME:
Journal of Biomedical Science and Engineering,
Vol.19 No.5,
May
26,
2026
ABSTRACT: 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.