Therapeutic Management of Chronic Venous Insufficiency: Microcirculation as a Target

Abstract

Chronic venous insufficiency, in its most severe manifestations as well as in its mild form, is linked to venous valve failure, weakness of the venous wall, and leukocyte-endothelial interactions all of which lead to cutaneous and subcutaneous tissue changes. These in turn are related to venous hypertension-induced leukocyte activation, which may provide a target for pharmacotherapeutic intervention. Currently, surgical attack is focused on correction of the sources of venous hypertension, but it is felt that this provides a crude method that hopefully will be replaced by more precise pharmacological interventions. Microcirculation (2000) 7, S23-S28.Therapeutic management of chronic venous insufficiency JJ Bergan and GW Schmid-Schö nbein S27Therapeutic management of chronic venous insufficiency JJ Bergan and GW Schmid-Schö nbein S28

Valvular Density Alone Cannot Account for Sites of Chronic Venous Insufficiency and Ulceration in the Lower Extremity

“…Our clinical results with microvenous valvular transplantation in these patients, using cutaneous flaps, show significant improvement of tissue repair with no evidence of occurrence on a long-term basis (2,3,9). These and other reports (1,3,7,9,10), together with the findings on the microvenous valvular mapping in the human lower extremity described in the current study, suggest that the role of venous valves might be selective (i.e., damaged deep large valves rather contribute to pressure elevation in chronic venous insufficiency), while microvenous valves in dermis and subdermis (current study) may rather contribute, at least to a certain extent, to a redistribution of venous blood (5,18). Valves in large vessels (e.g., in the heart) close by the action of inertial fluid stress (13), while in contrast, small valves in the microcirculation use viscous fluid stress to close (23).…”

A Review of the Microcirculation in Skin in Patients With Chronic Venous Insufficiency: The Problem and the Evidence Available for Therapeutic Options

“…40 They present new targets for pharmacologic intervention in CVI. 41 Lymph drainage is intimately linked with the venous drainage. Lymphatics frequently fail in venous disease, especially in more advanced stages.…”