Abstract
Venous ulceration is caused by the disorganization of the microcirculation that is induced by prolonged venous hypertension. The most common cause of calf pump inefficiency that permits superficial venous hypertension during exercise is deep vein thrombosis. Venous hypertension causes venular dilatation and an increased capillary permeability. Fibrin is deposited around the capillaries and not removed because of a vein wall deficiency of the fibrinolytic activator. The fibrin acts as a diffusion barrier and the overlying dermis becomes anoxic. Any minor trauma then causes an ulcer. Ulcers can be cured by restoring calf pump function to normal. Postthrombotic skin changes caused by irreparable calf pump damage can be reversed by the regular use of elastic compression and the pharmacological long-term enhancement of fibrinolysis.
Résumé
L'ulcère variqueux est dû à l'altération de la microcirculation provoquée par l'hypertension veineuse de longue durée. La cause la plus commune de l'inefficacité de la pompe musculaire du mollet à l'origine de l'hypertension du système veineux superficiel qui s'exprime au cours de l'exercice est la thrombose veineuse profonde. L'hypertension veineuse provoque la dilatation des veinules et une hyperperméabilité capillaire. La fibrine se dépose autour des capillaires et ne disparaÎt pas en raison d'une déficience de l'activateur fibrinolytique de la paroi veineuse. La fibrine se comporte comme une barrière qui provoque l'anoxie des tissus sus-jacents. Un traumatisme minime peut provoquer un ulcère. L'ulcère variqueux peut Être guéri par le rétablissement de la fonction de pompe des muscles du mollet. Les modifications cutanées post-thrombotiques provoquées par l'irréparable altération de ce mécanisme peuvent Être traitées avec succès par l'emploi régulier de la compression élastique et par le renforcement à long terme de la fibrinolyse grâce aux agents pharmacologiques.
Resumen
La ulceración venosa es causada por desorganización de la microcirculacíon que induce una prolongada hipertensión venosa. La causa más comÚn de ineficiencia de la bomba muscular de la pantorrilla, la cual hace posible el desarrollo de hipertensión venosa superficial en el curso del ejercicio, es la trombosis de las venas profundas. La hipertensión venosa causa dilatación de las vénulas y un aumento de la permeabilidad capilar. Esto resulta en depósitos de fibrina alrededor de los capilares, fibrina que no puede ser removida debido a una deficiencia del activador de fibrinolisis en la pared de la vena. La fibrina actÚa como una barrera para la difusión de oxígeno, con lo cual la dermis se hace anóxica. Ahora cualquier trauma menor puede iniciar la ulceración. Las Úlceras pueden ser curadas restaurando la función de bombeo de la pantorrilla a su estado normal. Las alteraciones postrombóticas de la piel causadas por daño irreparable de la bomba de la pierna pueden ser corregidas mediante el uso regular de compresión elástica y el incremento farmacológico prolongado de la fibrinolisis.
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Browse, N.L. The etiology of venous ulceration. World J. Surg. 10, 938–943 (1986). https://doi.org/10.1007/BF01658644
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DOI: https://doi.org/10.1007/BF01658644