Chronic venous insufficiency: a new concept to understand pathophysiology at the microvascular level

Abstract

Objectives:

The real mechanism for the development of the later stages of chronic venous insufficiency still remains unclear. Venous hypervolemia and microvascular ischemia have been reported to be the consequences of venous insufficiency. The aim of this study was to investigate the effects of induced venous hypovolemia by dorsiflexion exercise in patients with venous leg ulcers.

Methods:

Thirty-six participants, all of whom had an ankle brachial pressure index between 0.8 and 1.2 mmHg, were chosen for this study. The participants were divided into two groups: Group A, a non-exercise group and Group B which performed regular exercise in the form of dorsiflexion. The basic assessment, including the history and examination, ankle-brachial pressure index (ABPI), Duplex scan and tcPO₂ measurements, was performed on two occasions at the beginning of the trial and after three months.

Results:

The tcPO₂ level was low in the beginning in all the subjects, but the picture was different at the end of the trial. There was a significant increase in the tcPO₂ level (p<0.001) in the patients who performed exercise while there was no difference in the measurements (p>0.05) in the non-exercise group.

Conclusions:

Induced venous hypovolemia through regular evacuation of the peripheral venous system improved tissue oxygenation at skin level. Venous hypervolemia may be the main contributing factor for the development of venous hypoxia and microvascular ischemia.

Keywords

venous hypervolemia ulcer exercise hypoxia

Get full access to this article

View all access options for this article.

References

Nelson

Harper

Prescott

Gibson

Brown

Ruckley

CV.

Prevention of recurrence of venous ulceration: randomized controlled trial of class 2 and class 3 elastic compression. J Vasc Surg 2006; 44: 803–808.

Manalo

Patel

Tiongson

Pryor

Uncommon leg ulcers in the lower extremity. J Vasc Surg 2007; 45: 568–573.

Rice

Desai

Cummings

Birnbaum

Skornicki

Parsons

Burden of venous leg ulcers in the united states. J Med Econ 2014; 5: 347–356.

Rabe

Pannier

Societal costs of chronic venous disease in CEAP C4, C5, C6 disease. Phlebology 2010; 1: 64–67.

Valencia

Falabella

Kirsner

Eaglstein

Chronic venous insufficiency and venous leg ulceration. J Am Acad Dermatol 2001; 3: 401–421.

Collins

Seraj

Diagnosis and treatment of venous ulcers. Am Fam Physician 2010; 15: 989–996.

Yarwood-Ross

Haigh

Managing a venous leg ulcer in the 21st century, by improving self-care. Br J Community Nurs 2012; 17: 462–465.

Alavi

Sibbald

Phillips

et al . What’s new: management of venous leg ulcer: treating venous leg ulcers. J Am Acad Dermatol 2016; 74: 643–664.

Franzeck

Haselbach

Speiser

Bollinger

Microangiopathy of cutaneous blood and lymphatic capillaries in chronic venous insufficiency. Yale J Biol Med 1993; 66: 37–46.

10.

Steins

Hafher

Hahn

Junger

Microcirculation in chronic venous insufficiency. Phlebology 2002; 17: 115–120.

11.

Khan

SR.

Six-month exercise training program to treat post-thrombotic syndrome: a randomized controlled two-centre trial. CMJA 2011; 183: 37–44.

12.

Padberg

FT.

Improving management of chronic venous disorders: exploration, description and understanding parallels in the worlds of the Renaissance and the American Venous Forum. J Vasc Surg 2005; 41: 355–365.

13.

Abbade

Lastoria

Venous ulcer: epidemiology, physiopathology, diagnosis and treatment. Int J Dermatol 2005; 44: 449–456.

14.

Lazarus

Mahmud

Umair

Nisa

Chronic venous leg ulcer treatment: future research needs. Wound Rep Reg 2014; 22: 34–42.

15.

Chealte

Sarin

Coleridge Smith

Scurr

The pathogenesis of skin damage in venous disease: a review. Eur J Vasc Surg 1991; 2: 115–123.

16.

Falanga

Eaglstein

WH.

The “trap” hypothesis of venous ulceration. Lancet 1993; 341: 1006–1008.

17.

Seshadri

Orla

Tamekia

LJ.

Endovenous management of venous leg ulcers. J Vasc Surg 2013; 1: 165–172.

18.

Moffat

Kommala

Dourdin

Choe

Venous leg ulcers: patient concordance with compression therapy and its impact on healing and prevention of recurrence. Int Wound J 2009; 6: 386–893.

19.

Van Gent

Catarinella

Lam

et al . Conservative versus surgical treatment of venous leg ulcers: 10-year follow-up of a randomized, multicenter trial. Phlebology 2015; 30: 35–41.

20.

Pappas

Duran

Hobson

. Pathology and cellular physiology of chronic venous insufficiency. In Gloviczki

Yao

eds. Handbook of Venous Disorders 2nd ed. New York, NY: Arnold Publisher; 2001: pp. 11–24.

21.

Clyne

Ramsden

Chant

Webster

JH.

Oxygen tension on the skin of the gaiter area of limbs with venous disease. Br J Surg 1985; 72: 644–647.

22.

Rosaria Cesarone

Belcaro

Errichi

et al . Microcirculatory effects of Viatromb spray gel heparin in chronic venous insufficiency: evaluation of TcPO₂ and PCO₂ - a product evaluation study. Angiology 2008; 58: 21S–26S.

23.

Stegall

Muscle pumping in the independent leg. Circ Res 1966; 19: 180-190.

24.

Heinen

Borm

Van der Vleuten

Evers

Oostendorp

van Achterberg

The Lively Legs self-management programme increased physical activity and reduced wound days in leg ulcer patients: results from a randomized controlled trial. Int J Nurs Stud 2012; 49: 151–161.

25.

Nicholas

Andrea

Alejandra

Evidence based management of common chronic lower extremity ulcers. Dermatol Ther 2013; 26: 187–196.

26.

O’Brien

Finlayson

Kerr

Edwards

. Testing the effectiveness of a self-efficacy based exercise intervention for adults with venous leg ulcers: protocol of a randomised controlled trial. BMC Dermatol 2014; 14: 16.

Chronic venous insufficiency: a new concept to understand pathophysiology at the microvascular level - a pilot study