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 treatm ent 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 lipodermatoscler osis caused by chronic venous insufficiency and 15 control subjects we re studied in the supine and sitting positions. The laser Doppler prob e, incorporated in a polyethylene chamber, was applied to the lower le g 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 re corded laser Doppler flux blood cell velocity, and concentration of mo ving blood cells. Results: In patients in the supine position, 20 mm H g compression resulted in a median increase of 33% in laser Doppler fl ux, and a median increase of 79% in blood cell velocity, but higher pr essures caused a progressive decrease in laser Doppler flux and blood cell velocity. With the patient in the sitting position, compression u p to 60 mm Hg caused an increase in laser Doppler flux (median percent age increase at 20 mm Hg compression 84%) and blood cell velocity (med ian percentage increase at 20 mm Hg compression 22%). At 20 mm Hg comp ression, the concentration of moving blood cells decreased in the supi ne position (median percentage fall 27%) but did not change significan tly in the dependent position. The effects of compression in control s ubjects were similar to those in patients, but to a lesser degree. Con clusion: Our study suggests that compression treatment may achieve par t of its effect by causing an increase in the microcirculatory flow ve locity.