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Microvascular changes in chronic venous insufficiency--a review.
Cardiovasc Surg. 1995 Jun; 3(3):237-45.CS

Abstract

Chronic venous insufficiency is the result of an impairment of the main venous conduits, causing microvascular changes. The driving force responsible for the alterations in the microcirculation is probably the intermittently raised pressure propagated from the deep system into the capillaries. The capillaries are dilated, elongated and tortuous and their endothelium is injured (irregular luminal surface, increased cytopempsis, dilated interendothelial spaces). Through the latter an increased extravasation can be observed, leading to an enlarged pericapillary space, oedema in the interstitial tissue and to the clinical finding of swelling. Haemoglobin from extravasated erythrocytes and erythrocyte fragments in the pericapillary space is degraded to haemosiderin which is responsible for hyperpigmentation. Microthrombosis in the capillaries causes microinfarction and micronecrosis. Skin areas with severe microangiopathy have reduced numbers of perfused nutritional capillaries and are characterized by a low transcutaneous (tc) PO2. The increased blood flow in the deeper skin layers does not contribute to nutrition of the superficial skin layers. The microvascular ischaemia is patchy and appears to be the main factor determining trophic changes and venous ulceration. The process of microinfarction and micronecrosis is followed by the formation of a granulation tissue, proliferation of capillaries and fibroblasts and finally wound healing by formation of scar tissue destroying the microlymphatic network. Clinically this process leads to lipodermatosclerosis, atrophy and in its most extreme form to ulceration where the compensating mechanisms are no longer able to repair the damage.

Authors+Show Affiliations

Department of Internal Medicine, University Hospital, Zurich, Switzerland.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

7655836

Citation

Leu, A J., et al. "Microvascular Changes in Chronic Venous Insufficiency--a Review." Cardiovascular Surgery (London, England), vol. 3, no. 3, 1995, pp. 237-45.
Leu AJ, Leu HJ, Franzeck UK, et al. Microvascular changes in chronic venous insufficiency--a review. Cardiovasc Surg. 1995;3(3):237-45.
Leu, A. J., Leu, H. J., Franzeck, U. K., & Bollinger, A. (1995). Microvascular changes in chronic venous insufficiency--a review. Cardiovascular Surgery (London, England), 3(3), 237-45.
Leu AJ, et al. Microvascular Changes in Chronic Venous Insufficiency--a Review. Cardiovasc Surg. 1995;3(3):237-45. PubMed PMID: 7655836.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Microvascular changes in chronic venous insufficiency--a review. AU - Leu,A J, AU - Leu,H J, AU - Franzeck,U K, AU - Bollinger,A, PY - 1995/6/1/pubmed PY - 1995/6/1/medline PY - 1995/6/1/entrez SP - 237 EP - 45 JF - Cardiovascular surgery (London, England) JO - Cardiovasc Surg VL - 3 IS - 3 N2 - Chronic venous insufficiency is the result of an impairment of the main venous conduits, causing microvascular changes. The driving force responsible for the alterations in the microcirculation is probably the intermittently raised pressure propagated from the deep system into the capillaries. The capillaries are dilated, elongated and tortuous and their endothelium is injured (irregular luminal surface, increased cytopempsis, dilated interendothelial spaces). Through the latter an increased extravasation can be observed, leading to an enlarged pericapillary space, oedema in the interstitial tissue and to the clinical finding of swelling. Haemoglobin from extravasated erythrocytes and erythrocyte fragments in the pericapillary space is degraded to haemosiderin which is responsible for hyperpigmentation. Microthrombosis in the capillaries causes microinfarction and micronecrosis. Skin areas with severe microangiopathy have reduced numbers of perfused nutritional capillaries and are characterized by a low transcutaneous (tc) PO2. The increased blood flow in the deeper skin layers does not contribute to nutrition of the superficial skin layers. The microvascular ischaemia is patchy and appears to be the main factor determining trophic changes and venous ulceration. The process of microinfarction and micronecrosis is followed by the formation of a granulation tissue, proliferation of capillaries and fibroblasts and finally wound healing by formation of scar tissue destroying the microlymphatic network. Clinically this process leads to lipodermatosclerosis, atrophy and in its most extreme form to ulceration where the compensating mechanisms are no longer able to repair the damage. SN - 0967-2109 UR - https://www.unboundmedicine.com/medline/citation/7655836/Microvascular_changes_in_chronic_venous_insufficiency__a_review_ L2 - https://linkinghub.elsevier.com/retrieve/pii/096721099593871L DB - PRIME DP - Unbound Medicine ER -