Correlation of severity of chronic venous disease with capillary morphology assessed by capillary microscopy

BackgroundIn patients with lipodermatosclerosis caused by chronic venous disease of the lower limb, the skin capillaries show proliferation and convolution. To our knowledge, no previous attempt has been made to correlate the clinical severity of venous disease based on the CEAP classification with the capillary morphology changes. The purpose of this study was to correlate the clinical severity with the capillary morphology changes in patients with chronic venous disease by using capillary microscopy and to explore the significance of atypical capillary morphology in patients with uncomplicated varicose veins.MethodPatients attending the vascular clinic for management of chronic venous disease were examined clinically and by duplex ultrasonography scans, and they were assigned to the appropriate CEAP clinical stage (C1, n = 15; C2, n = 20; C3, n = 15; C4a, n = 15; C4b, n = 15; C5, n = 15). Also studied were 10 control subjects with no arterial or venous disease of the lower limb. In part 1 of the study, a capillary microscope was used to obtain digital images of the skin microcirculation in the gaiter region. The capillary density and capillary convolutions were counted in a 2.4 mm2 region of skin. In part 2 of the study, a further 33 C2 and C3 patients were studied to provide more detailed information on a small subgroup with unusual capillary morphology.ResultsIn part 1 of the study, the capillary count was similar in controls and patients in CEAP stages C2 to C4a, but decreased in patients of groups C4b and C5 (median count: C2, 15; C4b, 4; and C5, 7). The median number of the capillary convolutions was 1 per capillary in patients of groups C1 to C3 and controls; C4a had 4 convolutions, C4b had 7, and C5 had ≥10. In part 2 of the study, an expanded group of 66 C2 and C3 patients was analyzed, of whom 14 had a mean capillary loop count of more than two. Biologic markers of inflammation were investigated for their correlation with capillary convolution, but no relationship was found.ConclusionsAmong patients with venous disease, increased capillary convolution is strongly associated with the more severe stages (lipodermatosclerosis and healed ulceration). The significance of atypically increased capillary convolutions in a small subgroup of C2/C3 patients remains unknown.