Today we are presenting a review of chronic venous disease published in the New England Journal of Medicine in 2006. Chronic venous disease and resultant ulcerations are the most commonly encountered problem treated in most wound care centers accounting for 70-80% of all ulcerations treated. In one study as many as 80% of people randomly sampled had some for of varicose veins in the general population.

Prevalence data reveals that risk for venous disease increases with age, is slightly more prevalent in women and more common in patients of European heritage. Other risk factors include heredity, obesity, pregnancy, standing and greater height.

The pathophysiology of symptoms found in chronic venous hypertension and ulcerations is broken down into 3 major categories: venous hypertension, valve-vein wall changes, and pressure-shear stresses.

Venous hypertension usually is caused by reflux through incompetent valves, but you must include venous obstruction and ineffective calf-pump mechanism in the differential as well. The clinical signs of venous hypertension occur from high venous pressures that remain elevated for prolonged periods usually in a range of about 30-100mmHg before ulceration occurs.

Vein wall and valve changes that occur secondary to venous hypertension include an increase in type I collagen, making the wall of the vein stiff, weakening the wall by reducing elasticity. Elevated levels of cytokines are also found in the walls of varicose veins leading to localized damage.

Elevated venous pressures can be tolerated for a short time but when this becomes a persistent issue leukocyte adhesion, rolling and migration as well as cellular death and hemorrhage can occur.

When the mechanisms above take hold they lead to an inflammatory process that causes the characteristic skin changes of venous disease including venous eczema, hemosiderosis and lipodermatosclerosis.

Understanding the pathophysiologic mechanisms of this disease process can help us better treat and prevent ulcerations. Attached below is a link to the entire review article.

Began JJ, Chronic Venous Disease. N Engl J Med. 2006 Aug 3l355(5): 488-98