Avengers assemble

‘You get hurt, hurt ‘em back. You get killed….WALK it off.’ Those famous words from Captain America will LEAD us through this year's AVLS congress update on the microcirculation in venous leg ulcers (VLU.) How do we, as modern day heroes avenging the ravages of CVD, protect our citizens and keep them walking to live another day? These are the difficult questions we must always strive to answer. The VLU villain is ubiquitous, and will need to be attacked on multiple levels.

As the AVLS session on superficial and deep venous disease approaches the battle from a ‘satellite view’, the microcirculation update in the wound session will give you the up close and personal ‘street view.’ You will see actual hand-to-hand combat between those elements causing tissue destruction and those Avengers promoting wound healing. In last year's talk you met Ironman, M, Transformer, and Glycogirl. These Avengers play very important roles in VLU healing in their roles on: Iron deposition, Macrophage differentiation, Transforming Growth Factors (specifically β) and Glycocalyx integrity. We will review how hemosiderin staining on the surface results in macrophage congestion and failure to differentiate from the destructive M1 macrophage to the reconstructive M2 macrophage. We will revisit the building blocks created by Transforming Growth Factor-β and how these can be disrupted. Finally, the new kid on the block from last year, the Glycocalyx, will refresh your memory with its ability to act, not only as a barrier (which blows the old Starling Principal out of the water,) but also as a mechanical signal transducer that alters the shape and function of the vascular endothelium.