Medical compression stockings reduce hypertension of nailfold capillaries at the toe of patients with chronic venous insufficiency¹

Issue title: Special Issue in Honour of the Editor-in-Chief Prof. Dr. Ing. Friedrich Jung on his 70th Birthday

Article type: Research Article

Authors: Oelert, Anja^a | Kittel, Manuela^b | Hahn, Martin^c | Haase, Hermann^d | Jünger, Michael^{d; *}

Affiliations: [a] Dermatological Practice, Mönchhofstr. 3c, Heidelberg, Germany | [b] University Hospital, Tübingen, Germany | [c] Dermatological Practice, Heerstr. 44, Rottweil, Germany | [d] University Dermatology Clinic, University-Medicine, Greifswald, Germany

Correspondence: [*] Corresponding author: Michael Jünger, University Dermatology Clinic, University-Medicine, Greifswald, Germany. Tel.: +49 3834 86 6769; Fax: +49 3834 86 6772; E-mail: [email protected].

Note: [1] The manuscript is dedicated to Prof. F. Jung on the occasion of his 70th birthday.

Abstract: In five patients who suffered from chronic venous insufficiency clinical stage C4 (n = 3) and C6 (n = 2) the capillary blood pressure was measured twice by means of invasive direct cannulation of nailfold capillaries of the toe. During one measurement course the patients wore below knee medical compression stockings (40 mmHg) during the other they did not have compression therapy. With the patient in supine position, the CP was investigated by the servo-nulling technique under resting conditions and under dynamic conditions: the calf-muscle/ankle joint venous pump was simulated by means of inflating a blood pressure cuff, which surrounded the mid lower leg, to 60 mmHg for 60 s. Results: The simulated calf-muscle contraction induced a steep increase of CP with 5.65 mmHg/s (Q1 5.27 mmHg/s, Q3 5.92 mmHg/s), which was significantly (p = 0.013) reduced by MCS to 2.47 mmHg/s (Q1 1.65 mmHg/s, Q3 3.0 mmHg/s). Time needed to reach the max. CP was 11.35 s, which was lengthened by MCS to 23.4 s (p = 0.134). Conclusion: Compression therapy prevents capillary hypertension, the major hemodynamic reason for the development of advanced stages of chronic venous insufficiency which are defined by skin disease like hyperpigmentation, lipodermatosclerosis and ulcer.

Keywords: Chronic venous insufficiency, dermal capillary blood pressure, cutaneous microcirculation, dermal capillary hypertension, pathophysiology of chronic venous insufficiency, servo nulling pressure measurement

DOI: 10.3233/CH-189122

Journal: Clinical Hemorheology and Microcirculation, vol. 69, no. 1-2, pp. 115-121, 2018