Microangiopathy of the skin and the effect of leg compression in patients with chronic venous insufficiency.

PURPOSE The reasons for the efficacy of leg compression in the treatment of chronic venous insufficiency are not clear. We have used laser Doppler fluxmetry to assess the effect of external compression on the skin microcirculation. METHODS Fifteen patients with lipodermatosclerosis caused by chronic venous insufficiency and 15 control subjects were studied in the supine and sitting positions. The laser Doppler probe, incorporated in a polyethylene chamber, was applied to the lower leg underneath a blood pressure cuff. Pressures were applied from 10 to 100 mm Hg in increments of 10 mm Hg. A computer data logging system recorded laser Doppler flux blood cell velocity, and concentration of moving blood cells. RESULTS In patients in the supine position, 20 mm Hg compression resulted in a median increase of 33% in laser Doppler flux, and a median increase of 79% in blood cell velocity, but higher pressures caused a progressive decrease in laser Doppler flux and blood cell velocity. With the patient in the sitting position, compression up to 60 mm Hg caused an increase in laser Doppler flux (median percentage increase at 20 mm Hg compression 84%) and blood cell velocity (median percentage increase at 20 mm Hg compression 22%). At 20 mm Hg compression, the concentration of moving blood cells decreased in the supine position (median percentage fall 27%) but did not change significantly in the dependent position. The effects of compression in control subjects were similar to those in patients, but to a lesser degree. CONCLUSION Our study suggests that compression treatment may achieve part of its effect by causing an increase in the microcirculatory flow velocity.

[1]  J. Tooke,et al.  Impaired Postural Vasoconstriction: A Contributory Cause of Oedema in Patients with Chronic Venous Insufficiency , 1988 .

[2]  J. Calnan,et al.  Effects of external pneumatic intermittent compression on fibrinolysis in man. , 1973, Lancet.

[3]  N. Browse,et al.  Blood and vein-wall fibrinolytic activity in health and vascular disease. , 1977, British medical journal.

[4]  N. Browse,et al.  The fibrinolytic activity of varicose veins , 1979, The British journal of surgery.

[5]  S. P. K. Payne,et al.  Mechanism of action of external compression on venous function , 1992, The British journal of surgery.

[6]  L. Norgren.  Elastic compression stockings--an evaluation with foot volumetry, strain-gauge plethysmography and photoplethysmography. , 1988, Acta chirurgica Scandinavica.

[7]  B. Fagrell.  Vital capillary microscopy. A clinical method for studying changes of the nutritional skin capillaries in legs with arteriosclerosis obliterans. , 1973, Scandinavian journal of clinical and laboratory investigation. Supplementum.

[8]  Leachman Rd.  Venous ulceration, fibrinogen and fibrinolysis. , 1984, Annals of the Royal College of Surgeons of England.

[9]  Y. Fung,et al.  Vascular Endothelium‐Leukocyte Interaction: STICKING SHEAR FORCE IN VENULES , 1975, Circulation research.

[10]  Gert E. Nilsson,et al.  Evaluation of a Laser Doppler Flowmeter for Measurement of Tissue Blood Flow , 1980, IEEE Transactions on Biomedical Engineering.

[11]  J. Scurr,et al.  Skin Blood Flow in Chronic Venous Insufficiency , 1993 .

[12]  V. Kakkar,et al.  A physiological study of elastic compression stockings in venous disorders of the leg , 1980, The British journal of surgery.

[13]  Toyoichi Tanaka,et al.  Blood Velocity Measurements in Human Retinal Vessels , 1974, Science.

[14]  E H WOOD,et al.  Venous pressure in the saphenous vein at the ankle in man during exercise and changes in posture. , 1949, Journal of applied physiology.

[15]  C. Avnstorp,et al.  Transcutaneous PO2 and laser Doppler blood flow measurements in 40 patients with venous leg ulcers. , 1987, Acta dermato-venereologica.

[16]  C. McCollum,et al.  Sustained compression and healing of chronic venous ulcers. , 1988, BMJ.

[17]  J M Porter,et al.  The influence of elastic compression stockings on deep venous hemodynamics. , 1991, Journal of vascular surgery.

[18]  J. Dormandy,et al.  Causes of venous ulceration: a new hypothesis , 1988 .

[19]  M. Stern,et al.  In vivo evaluation of microcirculation by coherent light scattering , 1975, Nature.

[20]  K. Burnand,et al.  Venous lipodermatosclerosis: treatment by fibrinolytic enhancement and elastic compression. , 1980, British medical journal.

[21]  V. Kakkar,et al.  Graduated, static, external compression of the lower limb: A physiological assessment , 1980, The British journal of surgery.

[22]  P. Dyck,et al.  Evaluation of skin vasomotor reflexes by using laser Doppler velocimetry. , 1983, Mayo Clinic proceedings.

[23]  J. Tooke,et al.  Synchronous assessment of human skin microcirculation by laser Doppler flowmetry and dynamic capillaroscopy. , 1983, International journal of microcirculation, clinical and experimental.

[24]  G. Holloway,et al.  Laser Doppler measurement of cutaneous blood flow. , 1977, The Journal of investigative dermatology.

[25]  A. Nicolaides,et al.  Combined evaluation of postphlebitic limbs by laser doppler flowmetry and transcutaneous PO2/PCO2 measurements. , 1988, VASA. Zeitschrift fur Gefasskrankheiten.

[26]  C. Riva,et al.  Laser Doppler measurements of blood flow in capillary tubes and retinal arteries. , 1972, Investigative ophthalmology.

[27]  C W Smith,et al.  Effect of venous shear stress on CD18-mediated neutrophil adhesion to cultured endothelium. , 1990, Blood.

[28]  K. Burnand,et al.  The relationship between the number of capillaries in the skin of the venous ulcer‐bearing area of the lower leg and the fall in foot vein pressure during exercise , 1981, The British journal of surgery.

[29]  T. O'donnell,et al.  Effect of elastic compression on venous hemodynamics in postphlebitic limbs. , 1979, JAMA.

[30]  B. Sigel,et al.  Type of compression for reducing venous stasis. A study of lower extremities during inactive recumbency. , 1975, Archives of surgery.

[31]  Hippocrates,et al.  The Genuine Works Of Hippocrates , 1849 .

[32]  G. Belcaro.  Microvascular Evaluation by Laser—Dopper Flowmetry of the Effects of Centellase in the Treatment of Severe Venous Hypertension and Leg Ulcers , 1987 .

[33]  E. Wood,et al.  THE EFFECT OF EXERCISE AND BODY POSITION ON THE VENOUS PRESSURE AT THE ANKLE IN PATIENTS HAVING VENOUS VALVULAR DEFECTS. , 1949, The Journal of clinical investigation.

[34]  A. Nicolaides,et al.  Air-plethysmography and the effect of elastic compression on venous hemodynamics of the leg. , 1987, Journal of vascular surgery.

[35]  J. Scurr,et al.  The veno-arteriolar reflex in chronic venous insufficiency. , 1993, VASA. Zeitschrift fur Gefasskrankheiten.

[36]  E. F. Byars,et al.  Pneumatic calf compression, fibrinolysis, and the prevention of deep venous thrombosis. , 1980, Surgery.

[37]  W. Fegan,et al.  The effect of elastic stockings on superficial venous pressures in patients with venous insufficiency , 1974, The British journal of surgery.

[38]  B. Sigel,et al.  Compression of the deep venous system of the lower leg during inactive recumbency. , 1973, Archives of surgery.