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Microangiopathy of cutaneous blood and lymphatic capillaries in chronic venous insufficiency (CVI).
Yale J Biol Med. 1993 Jan-Feb; 66(1):37-46.YJ

Abstract

The severity of microangiopathy in patients with chronic venous insufficiency (CVI) determines the extent of the trophic disturbances of the skin. Resulting from valvular incompetence of deep and/or perforating veins and the accompanying venous outflow obstruction caused by deep venous thrombosis (DVT), the increased ambulatory venous pressure heads are transmitted retrograde into the microvasculature of the skin at the ankle region. In the present study, we have assessed the changes in the cutaneous microvasculature by dynamic fluorescence video microscopy, fluorescence microlymphography, and transcutaneous oxygen tension (tcPO2) measurements. In mild forms of CVI, capillary density, morphologic characteristics, and tcPO2 are still normal. Fluorescent light intensity is, however, significantly increased, indicating an increased transcapillary diffusion of sodium fluorescein (NaF) as a marker for enhanced leakage of the capillaries in the early stage of the disease. The pericapillary halo diameters are significantly enlarged, compared to controls (p < 0.01). In the severe stages of CVI and in patients with venous ulcers, capillary thromboses, probably caused by endothelium-blood cell interactions, may lead to a reduced capillary density. In order to enlarge the exchange surface area, the remaining skin capillaries become tortuous (capillary tufts). Parallel to the reduced capillary number, tcPO2 decreases and can be extremely low at the ulcer rim or at white atrophy spots. Fibrin cuffs are not a specific finding for venous ulceration and do not significantly impair oxygen diffusion. Fluorescence microlymphography permits visualization of the lymphatic capillaries of the superficial skin. In severe stages of CVI, the lymphatic capillary network at the medial ankle area is destroyed, and the remaining lymphatic capillary fragments have an increased permeability to FITC-dextran with a molecular weight of 150,000. These findings demonstrate a special lymphatic microangiopathy in CVI, suggesting an additional lymphatic component in the edema formation.

Authors+Show Affiliations

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

Pub Type(s)

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

Language

eng

PubMed ID

8256463

Citation

Franzeck, U K., et al. "Microangiopathy of Cutaneous Blood and Lymphatic Capillaries in Chronic Venous Insufficiency (CVI)." The Yale Journal of Biology and Medicine, vol. 66, no. 1, 1993, pp. 37-46.
Franzeck UK, Haselbach P, Speiser D, et al. Microangiopathy of cutaneous blood and lymphatic capillaries in chronic venous insufficiency (CVI). Yale J Biol Med. 1993;66(1):37-46.
Franzeck, U. K., Haselbach, P., Speiser, D., & Bollinger, A. (1993). Microangiopathy of cutaneous blood and lymphatic capillaries in chronic venous insufficiency (CVI). The Yale Journal of Biology and Medicine, 66(1), 37-46.
Franzeck UK, et al. Microangiopathy of Cutaneous Blood and Lymphatic Capillaries in Chronic Venous Insufficiency (CVI). Yale J Biol Med. 1993 Jan-Feb;66(1):37-46. PubMed PMID: 8256463.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Microangiopathy of cutaneous blood and lymphatic capillaries in chronic venous insufficiency (CVI). AU - Franzeck,U K, AU - Haselbach,P, AU - Speiser,D, AU - Bollinger,A, PY - 1993/1/1/pubmed PY - 1993/1/1/medline PY - 1993/1/1/entrez SP - 37 EP - 46 JF - The Yale journal of biology and medicine JO - Yale J Biol Med VL - 66 IS - 1 N2 - The severity of microangiopathy in patients with chronic venous insufficiency (CVI) determines the extent of the trophic disturbances of the skin. Resulting from valvular incompetence of deep and/or perforating veins and the accompanying venous outflow obstruction caused by deep venous thrombosis (DVT), the increased ambulatory venous pressure heads are transmitted retrograde into the microvasculature of the skin at the ankle region. In the present study, we have assessed the changes in the cutaneous microvasculature by dynamic fluorescence video microscopy, fluorescence microlymphography, and transcutaneous oxygen tension (tcPO2) measurements. In mild forms of CVI, capillary density, morphologic characteristics, and tcPO2 are still normal. Fluorescent light intensity is, however, significantly increased, indicating an increased transcapillary diffusion of sodium fluorescein (NaF) as a marker for enhanced leakage of the capillaries in the early stage of the disease. The pericapillary halo diameters are significantly enlarged, compared to controls (p < 0.01). In the severe stages of CVI and in patients with venous ulcers, capillary thromboses, probably caused by endothelium-blood cell interactions, may lead to a reduced capillary density. In order to enlarge the exchange surface area, the remaining skin capillaries become tortuous (capillary tufts). Parallel to the reduced capillary number, tcPO2 decreases and can be extremely low at the ulcer rim or at white atrophy spots. Fibrin cuffs are not a specific finding for venous ulceration and do not significantly impair oxygen diffusion. Fluorescence microlymphography permits visualization of the lymphatic capillaries of the superficial skin. In severe stages of CVI, the lymphatic capillary network at the medial ankle area is destroyed, and the remaining lymphatic capillary fragments have an increased permeability to FITC-dextran with a molecular weight of 150,000. These findings demonstrate a special lymphatic microangiopathy in CVI, suggesting an additional lymphatic component in the edema formation. SN - 0044-0086 UR - https://www.unboundmedicine.com/medline/citation/8256463/Microangiopathy_of_cutaneous_blood_and_lymphatic_capillaries_in_chronic_venous_insufficiency__CVI__ L2 - https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/8256463/ DB - PRIME DP - Unbound Medicine ER -