Blood vessels of the skin in chronic venous insufficiency; clinical and pathologic study.

This study concerns ain evaluation of the anatomicopathologic changes found in blood vessels of the skin in areas of venous insufficiency in the lower legs. These changes have been compared with the vascular structure in comparable areas of skin in normal persons. Apparently evidence of ar-teriolar damage is more a concomitant finding in the clinical picture of chronic venous insufficiency than are venular changes. This is demonstrated in a study of 30 patients. The vascular changes show no correlation with the condition of the skin at the site from which the biopsy material was taken. THE BASIC problem which was studied in this investigation may be stated as follows: In patients who show clinical evidence of chronic venous insufficiency, do the blood vessels of the skin in areas of venous in-sufficiency differ from those in comparable areas of skin in normal persons and, if so, what is the qualitative nature of the changes? Specimens of skin were obtained from the lower part of the leg in a group of patients in whom a diagnosis of chronic venous insuffi-ciency had been made. Specimens of skin from comparable areas in apparently normal persons (that is, normal from the standpoint of there being no evidence of any peripheral vascular disease) were then obtained for comparison. The group of patients with "chronic venous in-sufficiency" was carefully screened to exclude all persons who did not present very definite clinical evidence of venous insufficiency, such as varicose veins, edema following thrombo-phlebitis, or brawny induration. The material for study w",as obtained from specimens for biopsy from patients in the Section on Dermatology and Syphilology and from sections of skin taken at the site of incision (in the region of the ankle) in patients who underwent operation for treatment of varicose veins. Control material was obtained in cases in which necropsy was performed and in which there was no history of peripheral vascular disease or arterial hypertension. These specimens were obtained from comparable sites to those of the cases of chronic venous insufficiency and from persons in approximately the same age range. A detailed clinical analysis of the patients included in this study is being given elsewhere' and will be but briefly mentioned here. Sixteen control specimens of skin were obtained, 10 of which were from men and 6 from women. The oldest patient was 85 and the youngest 16 years of age. Thirty-one specimens of skin were …