Cutaneous Microcirculation in Skin Lesions Associated with Chronic Venous Insufficiency

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Abstract
There are various types of skin lesions in chronic venous insufficiency. To determine an association between different skin lesions and different changes in the cutaneous vascular bed. Twenty-eight patients with chronic venous insufficiency (CVI) without and with various types of skin lesions (ie, hyperpigmentation, lipodermatosclerosis, white atrophy, and venous ulcer) and 12 healthy control subjects were examined by video-capillaroscopy, transcutaneous oxygen tension measurement, photoplethysmography, and Doppler ultrasonography to detect disturbances of cutaneous microcirculation and venous macrocirculation. There were no significant differences between the different CVI groups with respect to their venous function disorder. However, important variations were noted in the cutaneous microcirculation. In all the patient groups, an increase in the mean halo diameter could be demonstrated even in clinically healthy skin. In all types of skin lesions, the mean capillary diameter was significantly enlarged. Severe morphological capillary changes and a significant reduction of the mean transcutaneous oxygen tension values were found in conjunction with lipodermatosclerosis and white atrophy and in the areas surrounding venous ulcers. The results of this study point to the conclusion that, once they have become established, microvascular disturbances play an independent role in the development of the skin lesions associated with CVI.