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Abstract

The microcirculatory component of the pathophysiology of venous ulceration is now attracting considerable research interests, but is still far from fully elucidated. Currently, the central role is filled by the inappropriately activated white cell and its interaction with the endothelium. Interstitial oedema, pericapillary fibrin cuff and capillary microthromboses could all fit in with this hypothesis. However, there are other demon strated changes, for instance in lymphatic drainage, intrinsic fibrinolysis and hemorheo logical changes which also need to be taken into account. The interaction between the microcirculatory changes is an obvious target for the systemic pharmacotherapy of venous ulceration.

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References

Franzeck UK , Bollinger A. , Huch R. , et al: Transcutaneous oxygen tension and capillary morphological characteristics and density in patients with chronic venous incompetence. Circulation 70:806-811, 1984.

Bollinger A. , Leu AJ : Evidence for microvascular thrombosis obtained by intravital fluorescence videomicroscopy. Vasa 20:252-255, 1991.

Burnand KG , Whimster I. , Naidoo A. , et al: Pericapillary fibrin in the ulcer-bearing skin of the leg: The cause of lipodermatosclerosis and venous ulceration. Br Med J 285:1071-1072, 1982.

Homans J. : The aetiology and treatment of varicose ulcer of the leg. Surg Gynecol Obstet 24:300, 1917.

Stibe Ecl , Cheatle TR , Coleridge Smith PD , et al: Liposclerotic skin: A diffusion block or a perfusion problem ? Phlebology 5:231-236, 1990.

Le Devehat C. , Lemonie A. , Bertrand A. , et al: Hemorheological factors in the pathophysiology of venous disease. Rev Portuguese Hemorrheol 2:115-125, 1988.

Vanscheidt W. , Kresse O. , Hach-Wunderle V. , et al: Leg ulcer patients: No decreased fibrinolytic response but white cell trapping after venous occlusion of the upper limb . Phlebology 7:92-96, 1992.

Turitto VT : Platelet Rheology. Clinical Blood Rheology, vol 1., ed. by Lowe G.

Frangos JA , Eskin SG , McIntire LV , et al: Flow effects on prostacyclin production by cultured human endothelial cells. Science 227:1477-1479, 1985 .

10.

Nash GB , Shearman CP : Neutrophils and peripheral arterial disease. J Critical Ischemia 2:5-13.

11.

Thomas Prs , Nash GB , Dormandy JA : White cell accumulation in dependent legs of patients with venous hypertension: A possible mechanism for trophic changes in the skin. Br Med J 296:1693-1695, 1988.

12.

Loosemore TL , Dormandy JA : In: Physiology and Pathophysiology of Leukocyte Adhesion, ed. by Granger N , Schmid-Schonbein G. Oxford: Oxford University Press, 1995, pp 447-457.

13.

Shields DA , Andaz SK , Abeysinghe RD , et al: Plasma lactoferrin as a marker of white cell degranulation in venous disease. Phlebology 9:55-58, 1994.

14.

Shields DA , Andaz SK , Sarin S. , et al: Plasma elastase in venous disease. BJS 81:1496-1499, 1994.

15.

Whiston RJ , Hallett MB , Davies EV , et al: Inappropriate neutrophil activation in venous disease. BJS 81(10):695-698, 1994.

16.

Partsch H. : Lymphangiopathie bei chronischer veneninsuffizienz. Phlebol Proktol 15:85-89, 1985.

17.

Bollinger A. , Jager K. , Geser A. , et al: Transcapillary and interstitial diffusion of Na-fluorescein in CVI with white atrophy. Int J Microcirc 2:5-17, 1982.

18.

Hasleback P. , Vollenweider U. , Moneta G. , et al: Microangiopathy in severe chronic venous insufficiency evaluated by fluorescence video-microscopy . Phlebology 1:159-169, 1986.

Pathophysiology of Venous Leg Ulceration—An Update

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