Skin, Veins and Legs^[*]

Summary

Skin, veins and legs are the three ingredients which compose together the symptom complex know as chronic venous insufficiency (CVI). High ambulatory venous pressure is transferred by simple physical laws to the skin microcirculation. The capillaries are not resistant to this high pressure and will leak water, erythrocytes and plasma proteins into the in-terstitium. The result is oedema, pigmentation, sclerosis, inflammation and ulceration. Although many forms of intervention for incompetent veins are available, compression therapy is still the cornerstone in the treatment of CVI. Beside the interface pressure, the stiffness of the compression material is essential. By increasing the stiffness the difference in pressure during walking increases and with this the massage effect of the therapy.

Thermo-ablation is the treatment for varicose veins today. Knowledge about the development and transfer of the intravascular heat is essential to understand this treatment. New experiments, specially about steam development from the heat source in the blood are of great importance for the success rate. Fine tuning in those physical parameters is needed to optimally this treatment.

Zusammenfassung

Haut, Venen und Beine sind die drei unterschiedlichen Faktoren, welche zusammen den Symptomenkomplex der chronisch-venösen Insuffizienz (CVI) formen. Hoher Venendruck überträgt sich beim Gehen durch einfache physikalische Gesetze auf die Mikrozirkulati-on der Haut. Die Kapillaren sind diesem hohen Druck nicht gewachsen, wodurch es zu einem Austritt von Wasser, Erythrozyten und Plasma-Proteinen in das Interstitium kommt. Dies re-sultiert in Ödemen, Pigmentierung, Entzündungen und Sklerose und letztendlich in Geschwüren. Obwohl es verschiedene Behandlungmöglichkeiten inkompetenter Venen gibt, bleibt die Kompressionstherapie nach wie vor der Grundstein in der Behandlung der CVI. Neben dem Druck der Berührungsfläche ist die Steifigkeit des elastischen Materials entscheidend. Bei einer Erhöhung der Steifigkeit wird der Druckunterschied beim Gehen gesteigert und erhöht den Massage-Effekt der Therapie.

Die endoluminale thermische Ablation der varikösen Gefäße ist heutzutage die Therapie der Wahl. Die Kenntnis über das Entstehen und die Weiterleitung der intravaskulären Wärme ist wichtig, um diese Behandlung bes-ser zu verstehen. Neueren Untersuchungen, speziell über die Dampfentwicklung von Wärmequellen im Blut wird große Bedeutung beigemessen. Eine Feinabstimmung dieser physikalischen Parameter ist zur Verbesserung der Behandlungsresultate notwendig.

Keywords

Chronic venous insufficiency - Microcirculation - Skin alterations

Schlüsselwörter

Chronisch-venöse Insuffizienz - Mikrozirkulation - Hautveränderungen

^* Vortrag anlässlich der Verleihung der Max-Ratschow-Medaille 2011 in Berlin

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