Effect of leg elevation on the skin microcirculation in chronic venous insufficiency

Abstract

Leg elevation is advised in the treatment of venous disease associated with edema. We have used laser Doppler fluxmetry to assess the effects of leg elevation on the skin microcirculation. Methods: Fifteen patients with lipodermatosclerosis caused by chronic venous insufficiency and 15 control subjects were studied. Measurements were made from the liposclerotic skin of patients and 8 cm above the medial malleolus in control subjects. Laser Doppler flux, blood cell velocity, and concentration of moving blood cells were recorded with the subject lying in the supine position and after elevating the foot 30 cm above the heart level. Results: In subjects in the horizontal position, the resting laser Doppler flux was significantly higher in patients with lipodermatosclerosis than in control subjects (median difference 63 arbitrary units; 95% confidence interval: 36, 108). This difference was due to a higher concentration of moving blood cells in the patient group (median difference 6.5 arbitrary units; 95% confidence interval: 3.4, 9). The blood cell velocity was not statistically significant between the two groups. On leg elevation, there was a substantial increase in the laser Doppler flux in the patient group; the median percentage increase in flux was 45% (p < 0.01). This was due to an increase in blood cell velocity; the median percentage increase was 41% (p < 0.01). There was no corresponding change in the concentration of moving blood cells. The results in the control group showed a similar trend but have not reached statistical significance. Conclusion:We conclude that limb elevation enhanced the microcirculatory flow velocity in liposclerotic skin of patients with chronic venous insufficiency. (J VAsc SURG 1994; 20:705-10.) Limb elevation is often used in the treatment of venous disease associated with edema, ls It is lcnown to accelerate the healing of venous ulceration. In the treatment of venous leg ulceration associated with severe local edema, some authors recommend that patients are admitted to hospital for 48 hours' bed rest with limb elevation and physiotherapy, followed by compression treatment and mobilization. 4 Other authors have suggested vertical leg elevation for

Risk factors related to the failure of venous leg ulcers to heal with compression treatment

“…12 Published healing rates of venous ulcers obtained with compression therapy vary widely from 40-95%. [4][5][6][7][8][9][10] Unfortunately, a significant number of venous ulcers remain refractory to compression treatment.…”

Management of venous leg ulcers: Clinical practice guidelines of the Society for Vascular Surgery® and the American Venous Forum

“…Leg elevation is effective in patients with C4 disease by increasing microcirculatory flow. 542 Although employing only a surrogate measure, a prospective study of exercise in 20 patients showed similar results in C5 patients, with an improvement in calf muscle pump function. 543 A structured review also suggested a positive effect of exercise (ambulation) on calf muscle pump function, although not directly assessed for VLU occurrence.…”

Chronic Venous Insufficiency and Venous Ulceration

“…Simple elevation of the legs above heart level for 30 minutes three or four times per day is effective in reducing edema and improving the cutaneous microcirculation in patients with CVI. 67,68 In more advanced disease, leg elevation alone will not be sufficient, and most experts consider compression stockings an essential treatment modality. 42 69,79 Compression therapy has also been shown to enhance fibrinolysis, [80][81][82] and it may be an important mechanism in reducing fibrosis and promoting ulcer healing.…”