To evaluate whether microcirculatory disturbances of the skin in patients with chronic venous insufficiency are a generalized phenomenon or restricted to visible skin changes.
Design:
Open, prospective study in patients and healthy, age-matched subjects.
Setting:
Department of Angiology, Hannover Medical School.
Patients:
Seventy-one patients with chronic venous insufficiency.
Measurements:
Transcutaneous oxygen pressure (tcPo2) at electrode core temperatures of 37°C and 44°C and laser Doppler flux (LDF) were measured simultaneously in different regions of the legs.
Results:
On the forefoot, tcPo2 (37°C) at rest and tcPo2 (44°C) during arterial ischaemia were significantly higher in patients (P<0.05), increasing with the severity of chronic venous insufficiency.
Conclusions:
Cutaneous capillary flow on the forefoot is increased in patients with chronic venous insufficiency, demonstrating the general effect of venous hypertension.
BollingerAJägerKGeserASgierFSegliasJ. Transcapillary and interstitial diffusion of Na-fluorescein in chronic venous incompetence with white atrophy. Int J Microcirc: Clin Exp1982;1: 5–17.
2.
FranzeckUKBollingerAHuchRHuchA. Transcutaneous oxygen tension and capillary morphologic characteristics and density in patients with chronic venous incompetence. Circulation1984; 5: 806–11.
3.
LeuAJYanarAPfisterGGeigerMFranzeckUKBollingerA. Mikroangiopathie bei chronischer venöser Insuffizienz. Dtsch Med Wschr1991; 116: 447–53.
4.
WidmerLKStähelinHBNissenCDa SilvaA. Venen-Arterienkrankheiten, koronare Herzkrankheit bei Berufstätigen. Prospektiv-epidemiologische Untersuchung. Basler Studie I–III. Bern: Huber, 1981: 69.
5.
TookeJEØstergrenJFagrellB. Synchronous assessment of human skin microcirculation by laser Dopper flowmetry and dynamic capillaroscopy. Int J Microcirc: Clin Exp1983;2: 277–84.
6.
EwaldURoothGTuvemoR. Postischaemic hyperaemia studied with a transcutaneous oxygen electrode used at 33–37°C. Scand J Clin Lab Invest1981; 41: 641–5.
7.
CreutzigADauDCasparyLAlexanderK. Transcutaneous oxygen pressure measured at two different electrode core temperatures in healthy volunteers and patients with arterial occlusive disease. Int J Microcirc: Clin Exp1987;5: 373–80.
8.
CreutzigACasparyLHertelRFAlexanderK. Temperature-dependent laser Doppler fluxmetry in healthy controls and patients with peripheral arterial occlusive disease. Int J Microcirc: Clin Exp1987;6: 381–90.
9.
FagrellB. Microcirculatory disturbances – the final cause for venous leg ulcers?Vasa1982; 11: 101–3.
10.
CreutzigACasparyLAlexanderK. Disturbances of skin microcirculation in patients with chronic arterial occlusive disease and venous incompetence. Vasa1988; 17: 77–83.
11.
ClyneCACRamsdenWHChantADBWebsterJHH. Oxygen tension on the skin of the gaiter area of limbs with venous disease. Br J Surg1985; 72: 644–7.
12.
CreutzigAWuppermannThHanauskeUWrabetzWAlexanderK. Sauerstoffdruckfelder in Unterschenkelgeschwüren. Hautarzt1985; 36: 612–6.
13.
WennerALeuHJSpycherMBrunnerU. Ultrastructural changes of capillaries in chronic venous insufficiency. Exp Cell Biol1980; 48: 1–14.
14.
ThomasPRSNashGBDormandyJA. White cell accumulation in dependent legs of patients with venous hypertension. A possible mechanism for trophic changes in skin. Br Med J1988; 296: 1693–6.
15.
FalangaVEaglesteinWH. The 'trap' hypothesis of venous ulceration. Lancet1993; 341: 1006–8.
16.
HollingHEBeecherHKLintonRR. Study of the tendency to edema formation associated with incompetence of the valves of the communicating veins of the leg. Oxygen tension of the blood contained in varicose veins. J Clin Invest1938; 17: 555–61.
17.
KolariPJPekanmakiKPohjolaRT. Transcutaneous oxygen tension in patients with postthrombotic leg ulcers: Treatment with intermittent pneumatic compression. Cardiovasc Res1988; 22: 138–41.
18.
BurnandKGWhimsterINaidooABrowseNL. Pericapillary fibrin in the ulcer-bearing skin of the leg: The cause of lipodermatosclerosis and venous ulceration. Br Med J1982; 285: 1071–2.
19.
BaslevEThomsenHKDanielsenLWarburgF. The occurrence of pericapillary fibrin in venous hypertension and ischaemic leg ulcers: A histopathological study. Br J Dermatol1992; 126: 582–5.
20.
VanscheidtWStengeleKWokalekHSchöpfE. Perikapilläre Fibrinmanschetten – ein O2-Diffusionsblock?Vasa1991; 20: 142–6.
21.
LeuHJ. Morphology of chronic venous incompetence – light and electron microscopic examinations. Vasa1991; 20: 330–4.
22.
CheatleTRSmithPD ColeridgeScurrJH. Skin microcirculatory responses in chronic venous incompetence: The effect of short-term venous hypertension. Vasa1991; 20: 63–9.
23.
CheatleTRShamiSKStibeESmithPD ColeridgeScurrJH. Vasomotion in venous disease. J R Soc Med1991; 84: 261–3.
HopkinsNF GowlandSpinksTJRhodesCGRanicarASOJamiesonCW. Positron emission tomography in venous ulceration and liposclerosis: Study of regional tissue function. Br Med J1983; 186: 333–6.
26.
LindemayrWLoffererOMostbeckAPartschH. Arteriovenous shunts in primary varicosis? A critical essay. Vasc Surg1972; 6: 9–14.
27.
CreutzigACasparyLvon der LiethHAlexanderK. Veränderungen des tcPo2 und LDF bei Patienten mit primärer Varikose vor und nach Varizenexhairese. Vasa1988; Suppl 23: 57–64.
28.
DoddHJGaylardePMSarkanyI. Skin oxygen tension in venous incompetence of the lower leg. J R Soc Med1985; 78: 373–6.
