John J. Bergan, M.D., Geert W. Schmid-Schönbein, Ph.D., Philip D. Coleridge Smith, D.M., Andrew N. Nicolaides, M.S., Michel R. Boisseau, M.D., and Bo Eklof, M.D., Ph.D.
Since this article has no abstract, we have provided an extract of the first 100 words of the full text and any section headings.
Chronic venous disease of the lower limbs is manifested by arange of signs, the most obvious of which are varicose veinsand venous ulcers. However, the signs also include edema, venouseczema, hyperpigmentation of skin of the ankle, atrophie blanche(white scar tissue), and lipodermatosclerosis (induration causedby fibrosis of the subcutaneous fat) (Figure 1). Considerableprogress has been made in understanding the mechanisms thatunderlie these diverse manifestations, in particular the roleof inflammation. This article reviews these advances and placesthem in a clinical context.
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Figure 1. Clinical Manifestations of Chronic Venous Disease.
Valve and Vein-Wall Changes in Chronic Venous Disease
Changes in Venous Valves
Structural Changes in the Vein Wall
Role of Pressure and Shear Stress
The Role of Elevated Pressure
The Role of Shear Stress
Skin Changes
Chronic Inflammation
Mechanisms of Inflammation
The Link between Inflammation and Skin Changes
Implications for Treatment
Source Information
From the Departments of Surgery (J.J.B.) and Bioengineering (G.W.S.-S.), Whitaker Institute of Biomedical Engineering, University of California, San Diego, La Jolla; the Department of Vascular Surgery, Royal Free and University College Medical School, Middlesex Hospital, London (P.D.C.S.); the Department of Surgery, Imperial College London, University of Cyprus, and Vascular Screening and Diagnostic Centre, Nicosia, Cyprus (A.N.N.); the Department of Vascular Biology and Pharmacology, University of Bordeaux 2, Bordeaux, France (M.R.B.); and the Department of Surgery, University of Lund, Lund, Sweden (B.E.).
Address reprint requests to Dr. Bergan at 9850 Genesee, Suite 410, La Jolla, CA 92037, or at jbergan@ucsd.edu.
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