REVIEW  VENOUS DISEASE Editor’s choice • Free access

International Angiology 2021 December;40(6):457-69

DOI: 10.23736/S0392-9590.21.04664-2

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

Chronic venous disease and diabetic microangiopathy: pathophysiology and commonalities

Giacomo GASTALDI ¹, Felizitas PANNIER ^{2, 3}, Karel ROZTOČIL ⁴, Marzia LUGLI ⁵, Armando MANSILHA ^{6, 7}, Hermann HALLER ⁸, Eberhard RABE ⁹, Marie Josee VAN RIJN ¹⁰ ✉

¹ Division of Endocrinology Diabetology Nutrition and Patient Education, Geneva University Hospitals, Geneva, Switzerland; ² Private Clinic Phlebology and Dermatology, Bonn, Germany; ³ Department of Dermatology, University of Cologne, Cologne, Germany; ⁴ Department of Transplantational and Vascular Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic; ⁵ Unit of Vascular Surgery, Cardiovascular Department, Hesperia Hospital, Modena, Italy; ⁶ Faculty of Medicine, University of Porto, Porto, Portugal; ⁷ Department of Angiology and Vascular Surgery, Hospital de S. João, Porto, Portugal; ⁸ Hannover Medical School, Department of Nephrology and Hypertension, Hannover, Germany; ⁹ Department of Dermatology (Emeritus), University of Bonn, Bonn, Germany; ¹⁰ Department of Vascular Surgery, Erasmus Medical Center, Rotterdam, the Netherlands

Chronic venous disease and diabetes mellitus are highly prevalent and debilitating conditions affecting millions of individuals globally. Although these conditions are typically considered as separate entities, they often co-exist which may be important in both understanding their pathophysiology and determining the best treatment strategy. Diabetes mellitus is twice as common in patients with chronic venous disease compared with the general population. Notably, a large proportion of patients with diabetes mellitus present with venous disorders, although this is often overlooked. The etiology of chronic venous disease is multifactorial, involving hemodynamic, genetic, and environmental factors which result in changes to the venous endothelium and structural wall as well as inflammation. Inflammation, endothelial dysfunction and hyperfiltration or leakage, are commonly observed in diabetes mellitus and cause various diabetic microvascular complications. Both diseases are also influenced by the increased expression of adhesion molecules, chemokines, and cytokines, and are characterized by the presence of vessel hypertension. Consequently, despite differences in etiology, the pathophysiology of both chronic venous disease and diabetic microangiopathy appears to be driven by endothelial dysfunction and inflammation. Treatment strategies should take the co-existence of chronic venous disease and diabetic microangiopathy into account. Compression therapy is recommended in inflammatory conditions that have an edema component as seen in both chronic venous disease and diabetes mellitus. Lifestyle changes like weight loss and exercise, will improve metabolic state and lower inflammation and should be promoted in these patients. Additionally, both patient populations may benefit from venoactive drugs.

KEY WORDS: Venous insufficiency; Diabetes mellitus; Diabetic angiopathies; Inflammation; Endothelium