THE MICROCIRCULATION IN VENOUS HYPERTENSION

Objective: To review the factors that result in skin ulceration of pat ients with chronic venous insufficiency, Data sources: Index Medicus w as searched using an on-line computer system for years 1966-1995 to id entify articles relating to venous ulceration and the microcirculation . Data extraction: Articles and sections of articles relating to the m echanisms which cause venous ulceration and the efficacy of the treatm ent of venous ulceration have been included. Data synthesis: It seems unlikely that venous ulceration is attributable to failure of diffusio n of oxygen and other small nutritional molecules to the tissues of th e skin. It is much more likely that neutrophils attach themselves to t he cutaneous microcirculation, become activated and produce endothelia l injury. Repeated over many months or years, this leads to the chroni c inflammatory process of lipodermatosclerosis. The microvascular chan ges in the skin are characterised by activated endothelium and perivas cular inflammatory cells. Conclusion: There is evidence of leucocyte i nvolvement in the pathogenesis of venous ulceration. The exact mechani sms remain to be resolved. Improved treatment for patients may be devi sed with a better understanding of the basic causes of this condition.