Endothelial activation in patients with chronic venous disease.
OBJECTIVE
Leukocyte trapping due to leukocyte-endothelial activation has been implicated as the cause of lipodermatosclerosis and ulceration in patients with chronic venous disease. We investigated endothelial activity in normal controls and patients subjected to short-term venous hypertension.


METHODS
Twenty-five normal volunteers and 30 patients with chronic venous disease divided into two groups: varicose veins with skin changes (LDS, n = 15); and varicose veins without skin changes (VVs, n = 15) were studied. Blood samples were taken from a foot vein before and after experimental venous hypertension. Plasma levels of ELAM-1 (endothelial leukocyte adhesion molecule-1), ICAM-1 (intercellular adhesion molecule-1), VCAM-1 (vascular cell adhesion molecule-1), and von Willebrand factor (vWf) was measured by an ELISA.


RESULTS
There was a significant rise in the plasma concentration of ELAM-1, ICAM-1 and VCAM-1 in patients and normal controls in response to venous hypertension. Basal levels of plasma VCAM-1 and vWf were higher in patients with LDS compared to patients with VVs. The magnitude of rise of VCAM-1 was greater in patients with LDS compared to patients with VVs (p = 0.01, Mann-Whitney U-test). There was no difference in the basal levels or in the magnitude of change in plasma ICAM-1 and ELAM-1 between the two patient groups.


CONCLUSIONS
Venous hypertension results in endothelial activation which may aid endothelial-leukocyte adhesion. Patients with LDS exhibit increased VCAM-1, which is a counterligand for receptors expressed by monocytes and lymphocytes signifying that these cells may be more important in the development of skin changes.
Saharay
M
M
Department of Surgery, University College London Medical School, U.K.
Shields
D A
DA
Georgiannos
S N
SN
Porter
J B
JB
Scurr
J H
JH
Coleridge Smith
P D
PD
D000328:Adult; D000368:Aged; D001772:Blood Cell Count; D002908:Chronic Disease; D019040:E-Selectin / Q000097:blood; D004730:Endothelium, Vascular / Q000502:physiology*; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006486:Hemosiderosis / Q000150:complications / Q000503:physiopathology; D006801:Humans; D018799:Intercellular Adhesion Molecule-1 / Q000097:blood; D008297:Male; D008875:Middle Aged; D012016:Reference Values; D012594:Scleroderma, Localized / Q000150:complications / Q000503:physiopathology; D014648:Varicose Veins / Q000150:complications / Q000503:physiopathology*; D019010:Vascular Cell Adhesion Molecule-1 / Q000097:blood; D014690:Venous Pressure / Q000502:physiology*; D014841:von Willebrand Factor / Q000032:analysis
D019040:E-Selectin; D019010:Vascular Cell Adhesion Molecule-1; D014841:von Willebrand Factor; D018799:Intercellular Adhesion Molecule-1