TAILIEUCHUNG - Mechanisms of Disease Chronic Venous Disease

Chronic venous disease of the lower limbs is manifested by a range of signs, the most obvious of which are varicose veins and venous ulcers. However, the signs also include edema, venous eczema, hyperpigmentation of skin of the ankle, atrophie blanche (white scar tissue), and lipodermatosclerosis (induration caused by fibrosis of the subcutaneous fat) (Fig. 1). Considerable progress has been made in understanding the mechanisms that underlie these diverse manifestations, in particular the role of inflammation. This article reviews these advances and places them in a clinical context | Mechanisms of Disease Chronic Venous Disease mechanisms of disease Chronic Venous Disease John J. Bergan . Geert W. Schmid-Schonbein . Philip D. Coleridge Smith . Andrew N. Nicolaides . Michel R. Boisseau . and Bo Eklof . . From the Departments of Surgery . and Bioengineering . Whitaker Institute of Biomedical Engineering University of California San Diego La Jolla the Department ofVascular Surgery Royal Free and University College Medical School Middlesex Hospital London . the Department of Surgery Imperial College London University of Cyprus and Vascular Screening and Diagnostic Centre Nicosia Cyprus . the Department of Vascular Biology and Pharmacology University of Bordeaux 2 Bordeaux France . and the Department of Surgery University of Lund Lund Sweden . . Address reprint requests to Dr. Bergan at 9850 Genesee Suite 410 La Jolla CA 92037 or at jbergan@. N Engl J Med 2006 355 488-98. Copyright 2006 Massachusetts Medical Society. Chronic venous disease of the lower limbs is manifested by a range of signs the most obvious of which are varicose veins and venous ulcers. However the signs also include edema venous eczema hyperpigmentation of skin of the ankle atrophie blanche white scar tissue and lipodermato-sclerosis induration caused by fibrosis of the subcutaneous fat Fig. 1 . Considerable progress has been made in understanding the mechanisms that underlie these diverse manifestations in particular the role of inflammation. This article reviews these advances and places them in a clinical context. Chronic venous disease can be graded according to the descriptive clinical etiologic anatomical and pathophysiological CEAP classification which provides an orderly framework for communication and decision 2 The clinical signs in the affected legs are categorized into seven classes designated Co to C6 Table 1 . Leg symptoms associated with chronic venous disease include aching heaviness a .

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