MICROCIRCULATORY ASPECTS OF VENOUS ULCERATION

BACKGROUND. Articles were identified from a literature search based on Index Medicus from 1983 onwards with additional, as yet, unpublished data obtained directly from ongoing research at The Middlesex Hospital Vascular Laboratory. Original scientific articles were selected if th ey addressed the mechanisms causing venous ulceration in relation to t he events in the microcirculation. OBJECTIVE. To review the mechanisms proposed recently to explain the pathogenesis of venous ulceration. R ESULTS. Recent data suggest that there is a systemic inflammatory resp onse associated with the presence of venous disease in the lower limb, as indicated by measuring plasma neutrophil elastase and lactoferrin. In volunteers without venous disease white cell activation may be pro duced by experimental venous hypertension lasting 30 minutes, produced by applying a venous tourniquet to the lower limb or by standing with out moving for 30 minutes. CONCLUSION. Inflammatory mechanisms play a significant role in the pathogenesis of venous disease but the exact m echanisms producing venous ulceration remain to be elucidated.