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White Cell Trapping Hypothesis in the Development and Pathogenesis of Venous Stasis Ulcers
Monday, August 12, 2013



The scientific question of how ambulatory venous hypertension causes leg ulceration or venous stasis ulceration has intrigued scientists for the last two decades.  The mechanism refers to the “white cell trapping hypothesis” that was proposed in 1988.


It has been shown that in patients with lipodermatosclerosis and venous stasis ulcers, venous hypertension is confined to the skin and subcutaneous tissue and the main focus of the damage is in the capillaries of the dermis. It has been shown that the amount of capillary tissue is increased in the skin and that many more capillary loops are found on histological or microscopic sections of damaged skin which have been biopsied.


Factors that causes this inflammatory process in the capillaries is venous hypertension or elevated pressures of the venous system which results in the sequestration or trapping of white blood cells or leukocytes in the microcirculation of the leg.  Patients with lipodermatosclerosis or venous stasis ulcers have been shown to trap leukocytes in the lower extremities.  These “trapped” leukocytes become activated and release proteolytic enzymes that are normally used in the defense mechanism to fight infection and inflammation.  These trapped leukocytes, in turn, cause injury to the capillary endothelium in which they are found.  Inappropriate activation of these leukocytes activates a series of pathophysiologic events that contributes to the development of venous stasis ulcers.   


Although the full mechanism of this is not completely understood and research is in progress, the incorporation of external compression stockings is the mainstay of treatment in patients with advanced venous disease.  External compression with elastic stockings prevents the pooling of blood in these capillaries and theoretically minimizes the risk of leukocyte trapping and subsequent tissue injury.


For evaluation and treatment of patients with venous stasis ulcers, contact Hratch Karamanoukian, MD FACS at the Vein Treatment Center with offices in Williamsville, New York and Clarence, New York or contact him via or call 716-839-3638 to schedule an appointment. and are partners with



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