The Venous Microcirculation

Numerous investigations have attempted to evaluate the microcirculation of patients with CVI.40,43-46 The majority of these investigations were qualitative descriptions of vascular abnormalities, which lacked uniformity of biopsy sites and patient stratification. Prior to 1997 it was widely accepted that endothelial cells from the dermal microcirculation appeared abnormal, contained Weibel-Palade bodies, were edematous, and demonstrated widened interendothelial gap junctions.45 Based on these descriptive observations it was assumed that the dermal microcirculation of CVI patients have functional derangements related to permeability and ulcer formation. It was not until 1997 that a quantitative morphometric analysis of the dermal microcirculation was reported.40 The objectives of this investigation were to quantify differences in endothelial cell structure and local cell type with emphasis on leukocyte cell type and their relationship to arterioles, capillaries, and post-capillary venules (PCVs). Variables assessed were number and types of leukocytes, endothelial cell thickness, endothelial vesicle density, interendothelial junctional width, cuff thickness, and ribosome density. Thirty-five patients had two four-millimeter punch biopsies obtained from the lower calf (gaiter region) and lower thigh. Patients were separated into one of four groups according to the 1995 ISCVS/SVS (International Society for Cardiovascular Surgery/Society for Vascular Surgery) CEAP classification.5 Group 1 consisted of five patients with no evidence of venous disease. Skin biopsies from these patients served as normal controls. Groups 2 through 4 consisted of patients with CEAP Class 4 (n = 11), Class 5 (n = 9), and Class 6 (n = 10) CVI.

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