Microcirculation in Chronic Venous Insufficiency

Abstract

Objective: To study the microcirculation of the skin of the leg in patients with chronic venous disease of the lower limb, and to assess the effect of compression treatment. Patients and Methods: Patients were recruited from the vascular clinic and investigated by direct capillary pressure, transcutaneous oxygen tension, intravital video capillaroscopy and fluorescence video microscopy. The microcirculation was observed over the healing period in patients with venous leg ulcers. The effects of compression therapy on microcirculatory changes were studied in patients with Widmer stage I and II chronic venous disease. Results: In patients suffering from lipodermatosclerosis or venous leg ulcers retrograde pressure waves were detected in the nutritive capillaries of the skin by the ‘servo nulling’ pressure measurement during simulated calf muscle contraction. A close correlation was found between the degree of trophic skin change and the microangiopathy observed. Healing of venous ulcers occurred only if the cutaneous microcirculation in the ulcer area improved. Capillary density in base of the ulcer and at the border predicted venous ulcer healing. Conclusions: Cutaneous microangiopathy precedes the development of trophic skin alterations due to chronic venous disease and microcirculatory changes are closely related to the clinical stage of the disease as well as to the outcome of treatment.