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RosenVeinLecture 104,Pt2: Why Bad Veins Happen To Good People

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Venous Pathophysiology, Part 2 The whole of the Chicagoland area…including Northbrook where Rosen Vein Care is located…was once burdened by a sheet of glacial ice that oppressively flowed southward from Wisconsin. But hey…that’s just a theory. It’s not as if there was a video camera catching the evidence as it happened over hundreds of thousands of years. And that’s science: making best guesses based on facts as best we can gather them. Gather enough repeatable facts and you have yourself a theory. If it holds up long enough to the nerditudinous scrutiny of your peers… they’ll call it a Law. The lamp of scientific inquiry has flickered its way into nearly every crevice of uncertainty regarding the workings of our world…our bodies included. Over the years, a few theories have surfaced regarding the progression of superficial venous insufficiency and its effects on the lower extremities. Here’s where the trail of our discussion regarding the pathophysiology of venous disease picks back up again. The Old Theories: 1. Venous Stasis Theory: Attributed to Dr Homans and formulated during the early-mid 20th century: Valve/vein wall failure→reflux→stagnant blood→increased pressure→prevents nutrients from getting to skin→skin changes 2. Diffusion Block Theory (Fibrin Cuff): Venous Hypertension→capillaries become “leaky” (any docs reading this would rather I state it thusly: a widening of the endothelial gap junctions occurs)→fibrinogen leaks out and forms “cuffs” around capillaries→creates a barrier to oxygen/nutrient diffusion to tissues→ epidermal cells die. However, recent evidence suggests that the cuff is made up of multiple different proteins (fibrin,collagen,laminin…) and seems to serve as the body’s way of maintaining vascular architecture in the face of an increase in mechanical load due to venous hypertension. So the cuff could have protective benefits. But, it’s out with the old theories and in with… The New Theory: Inflammatory Model of Venous Disease A beautiful and compelling case which wraps it all up in a nice package: Venous Hypertension→shear stress on endothelial cells that line the inside of vessels→increased permeability of the lining→White Blood Cells (especially macrophages for those still awake) & Red Blood Cells leak out→ WBC’s become activated and release […]