Microvascular changes in chronic venous insufficiency—a review

Leu, Anders J.; Leu, H. J.; Uk, Franzeck; Bollinger, A

doi:10.1016/0967-2109(95)93871-l

Cited by 82 publications

(52 citation statements)

References 46 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Both these cells have been observed by immunohistochemistry in the interstitium of dermal biopsies. 45 However, a recent morphometric assessment of the dermal microcirculation identified macrophages and mast cells only and questioned the role of lymphocytes in CVI dermal pathology. 46 The exact role of leukocytes in the pathogenesis of CVI is unknown, however, the presence of mast cells suggests a role in cytokine activation, tissue remodeling, or ulcer formation.…”

Section: Varicose Veinsmentioning

confidence: 98%

“…It has been assumed that these cytochemical events are responsible for the increased expression of ICAM-1 (intercellular adhesion molecule-1) on endothelial cells of microcirculatory exchange vessels observed in CVI dermal biopsies. 45 ICAM-1 is the activation dependent adhesion molecule utilized by macrophages and lymphocytes for diapedesis. Both these cells have been observed by immunohistochemistry in the interstitium of dermal biopsies.…”

Section: Varicose Veinsmentioning

confidence: 99%

“…The perivascular space is surrounded by extracellular matrix (ECM) proteins, forming a perivascular "cuff". 41,[43][44][45]47 This perivascular "cuff" and the accompanying collagen deposition are the sine qua non of CVI tissue damage. The role of the cuff and its cell of origin are not completely understood.…”

Section: Varicose Veinsmentioning

confidence: 99%

See 2 more Smart Citations

Primary chronic venous disorders

Meissner

Gloviczki

Bergan

et al. 2007

Journal of Vascular Surgery

166

159

View full text Add to dashboard Cite

Primary chronic venous disorders, which according to the CEAP classification are those not associated with an identifiable mechanism of venous dysfunction, are among the most common in Western populations. Varicose veins without skin changes are present in about 20% of the population while active ulcers may be present in as many as 0.5%. Primary venous disorders are thought to arise from intrinsic structural and biochemical abnormalities of the vein wall. Advanced cases may be associated with skin changes and ulceration arising from extravasation of macromolecules and red blood cells leading to endothelial cell activation, leukocyte diapedesis, and altered tissue remodeling with intense collagen deposition. Laboratory evaluation of patients with primary venous disorders includes venous duplex ultrasonography performed in the upright position, occasionally supplemented with plethysmography and, when deep venous reconstruction is contemplated, ascending and descending venography. Primary venous disease is most often associated with truncal saphenous insufficiency. Although historically treated with stripping of the saphenous vein and interruption and removal of major tributary and perforating veins, a variety of endovenous techniques are now available to ablate the saphenous veins and have generally been demonstrated to be safe and less morbid than traditional procedures. Sclerotherapy also has an important role in the management of telangiectasias; primary, residual, or recurrent varicosities without connection to incompetent venous trunks; and congenital venous malformations. The introduction of ultrasound guided foam sclerotherapy has broadened potential indications to include treatment of the main saphenous trunks, varicose tributaries, and perforating veins. Surgical repair of incompetent deep venous valves has been reported to be an effective procedure in nonrandomized series, but appropriate case selection is critical to successful outcomes.

show abstract

Section: Varicose Veinsmentioning

confidence: 98%

Section: Varicose Veinsmentioning

confidence: 99%

See 1 more Smart Citation

Primary chronic venous disorders

Meissner

Gloviczki

Bergan

et al. 2007

Journal of Vascular Surgery

166

159

View full text Add to dashboard Cite

show abstract

“…Increased expression of intercellular adhesion molecule-1 on endothelial cells of the microcirculation recruits macrophages, mast cells, and lymphocytes (grade: low/basic science-observational). 29,30 Leukocytes in the extracellular space are found to surround the capillaries and postcapillary venules with matrix proteins, forming a perivascular cuff (grade: low/ basic science-observational). 25,[27][28][29][30][31][32] The cuff is thought to prevent diffusion of nutrients and oxygen into the dermis, although it may have a protective role of providing support to the vascular tissue from increased mechanical stress (grade: very low/expert's opinion).…”

Section: Natural History and Progression Of Primary Chronic Venous DImentioning

confidence: 99%

Natural history and progression of primary chronic venous disorder

Davies¹,

Lim²

2010

Journal of Vascular Surgery

View full text Add to dashboard Cite

show abstract

“…1,2 The pathophysiology of PTS is not well understood but involves venous hypertension, capillary leak and tissue hypoxia, ultimately leading to venous insufficiency following a DVT. 3,4 Pain is a prominent symptom of PTS, while other signs and symptoms include itching, heaviness, edema, skin discoloration and leg ulcers. The development of PTS is associated with a diminished quality of life.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of a short course of complex lymphedema therapy or graduated compression stocking therapy in the treatment of post-thrombotic syndrome

et al. 2014

View full text Add to dashboard Cite

Treatment options for established post-thrombotic syndrome (PTS) are limited. Complex lymphedema therapy (CLT), a non-invasive treatment that improves lymphatic flow, may have the potential to improve PTS. We conducted a singlecenter, investigator-blind, randomized controlled trial of 31 patients with a clinically established diagnosis of PTS and compared the efficacy of graduated compression stockings alone (30-40 mmHg) with CLT, a treatment that includes compression stockings, exercise, patient education, skin care and lymphatic drainage. Primary outcomes were the 1-and 3-month changes in PTS severity by the Villalta score and disease-specific quality of life using the VEINES-QOL (Venous Insufficiency Epidemiological and Economic Study Quality of Life) questionnaire. Analysis was by intent-to-treat. We found from a baseline average score of 9.9 points, CLT reduced mean PTS severity scores by −2.4 points (p=0.02) at the 1-month and −2.3 points (p=0.05) at the 3-month follow-up. Score reductions with stockings only were similar at −2.1 (p=0.03) and −3.3 points (p=0.03) at 1 and 3 months. The differences in score between treatments were not significant. Neither treatment significantly changed the VEINES-QOL score except in patients with severe disease. Patients with moderate to severe PTS derived the greatest benefit from either therapy and the two therapies differentially impacted PTS signs and symptoms. We found a short course of lymphedema therapy and compression stockings offer similar benefit in patients with PTS; however, larger studies are needed to further explore the potential use of CLT in PTS, particularly in patients with more severe disease. ClinicalTrials.gov Identifier: NCT00633971.

show abstract

Microvascular changes in chronic venous insufficiency—a review

Cited by 82 publications

References 46 publications

Primary chronic venous disorders

Primary chronic venous disorders

Natural history and progression of primary chronic venous disorder

Efficacy of a short course of complex lymphedema therapy or graduated compression stocking therapy in the treatment of post-thrombotic syndrome

Contact Info

Product

Resources

About