Fibrinolytic activity of the arms and legs of patients with lower limb venous disease

Abstract

Clearance of subcutaneous 125I-labelled fibrin was prolonged from the legs but not from the arms of patients with uncomplicated varicose veins and patients with healed ulcers, compared with controls. The euglobulin clot lysis time (ECLT) of blood from the arms and legs of those with healed ulcers was prolonged; venous congestion significantly shortened the ECLT of blood from all limbs except legs with healed ulcers. The clearance of interstitial fibrin of both legs and arms correlated with the response of the ECLT to venous congestion (P less than 0.05). The clearance of interstitial 125I-labelled albumin in five patients with healed ulcers was faster from the legs than from the arms, whereas the clearance of interstitial 125I-labelled fibrin was faster from the arms in all cases. These results suggest that there is a defect in interstitial fibrinolytic activity as well as vein wall production of plasminogen activator in legs with chronic venous insufficiency.

d-Dimer Levels are Significantly Increased in Blood Taken From Varicose Veins Compared With Antecubital Blood From the Same Patient

“…A subsequent study in 1991 compared venous blood samples from the antecubital vein with a dorsal foot vein in 11 control participants, 3 patients with varicose veins, and 21 patients with healed venous ulcers using the euglobulin clot lysis time (ECLT). 6 The results demonstrated that the ECLT of venous blood from the legs was significantly longer than that of the arm (P < .05). That same study also demonstrated delayed clearance of 125 I-labeled fibrinogen within subcutaneously injected clots from the calf compared with the arm in all cases.…”

“…This is because a reduction in fibrinolytic activity may be related to deep vein thrombosis (DVT), superficial vein thrombosis (SVT), chronic venous insufficiency (CVI), and varicose veins. [1][2][3][4][5][6] This has also been used to explain the presence of pericapillary fibrin cuffs in advanced venous disease and venous ulceration. 7,8 The studies referenced previously suggest that the fibrinolytic activity within the blood, venous wall, and tissue from legs is reduced when compared with the arm and this may be more pronounced in venous disease.…”

Morphological Changes in Lipodermatosclerosis and Venous Ulcers: Light Microscopy, Immunohistochemistry and Electron Microscopy

“…These results indicate enhanced fibrin formation in CVI [13]. Gajraj and Browse [14,15] investigated interstitial fibrinolytic activity by measuring the lysis rate of experimentally produced 125I-fibrin clots. In these experiments a low 53 fibrin half-life clearance correlates with a low tcP0 2 [14].…”

“…Gajraj and Browse [14,15] investigated interstitial fibrinolytic activity by measuring the lysis rate of experimentally produced 125I-fibrin clots. In these experiments a low 53 fibrin half-life clearance correlates with a low tcP0 2 [14]. The authors suggested that the impaired fibrinolytic activity is associated with a failure to produce plasminogen activator in veins of patients with CVI [15].Another hint suggesting failure of fibrinolysis within the perivascular cuff was given by immunohistological demonstration of plasminogen activator inhibitor [11].…”

Endogenous pro-thrombotic biomarkers from the arm and leg may not have the same value

“…21,22 A study in 1991 compared the fibrinolytic activity of plasma from the dorsal foot vein with the ante-cubital vein in 21 patients with healed venous ulcers and 11 normal subjects using the euglobulin clot lysis time (ECLT). 23 Interestingly, the ECLT from the legs was significantly longer than that of arm venous blood in both groups ( P < 0.05). This suggests a deficiency in fibrinolytic activity in the legs of both patients and controls and supports the hypothesis used in this current study that arm blood may not represent the processes that are happening in the leg.…”