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I think CVC cannot lead to heart failure primarily. So let's think its pathogenesis in skin now only.

I think the pathogenesis is like this

• dilation of veins and capillaries due to impaired venous drainage
• reduced outflow of blood from a tissue
• passive process
• $\to$ local increase in venous blood volume
• $\to$ local increase in venous pressure
• pathological
• $\to$ congested tissue, red cell stasis, accumulation of deoxygenated hemoglobin
• $\to$ shortage of oxygen and built-up metabolic waste
• $\to$ dusky reddish-bluish skin (cyanotic)
• Causes: venous thrombosis or edema; venous compression; heart failure.

What is the right pathogenesis of chronic venous congestion in skin?

I think CVC cannot lead to heart failure primarily. So let's think its pathogenesis in skin now only.

I think the pathogenesis is like this

• dilation of veins and capillaries due to impaired venous drainage
• reduced outflow of blood from a tissue
• passive process
• $\to$ local increase in blood volumes
• $\to$ local increase in venous pressure
• pathological
• $\to$ shortage of oxygen and built-up metabolic waste
• $\to$ structural changes in microvasculature
• $\to$ increased venous permeability % hallmark of acute inflammation
• $\to$ increased size of venous caliber
• $\to$ emigration of leucocytes
• $\to$ accumulation at site of injury
• activation of acute inflammation
• $\to$ protein into extravascular space
• $\to$ increased viscosity of blood
• $\to$ deoxygenated blood blood stasis
• $\to$ congested tissue
• $\to$ leucocytes move to endothelial wall (selectins)
• $\to$ roll
• $\to$ adhere (integrin to stop)
• $\to$ migrate
• $\to$ dysky reddish-bluish skin (cyanotic)
• $\to$ healing via fibrosis
• $\to$ scar
• Causes: venous thrombosis; venous compression; heart failure;

I am not sure about the role of leucocytes exactly in this process. I am not sure if they play a big role in the formation of cyanotic skin. I think the outcome is mostly because of increased vascular permeability and its deoxygenated blood in extracellular space.

What is the right pathogenesis of chronic venous congestion in skin?

I think CVC cannot lead to heart failure primarily. So let's think its pathogenesis in skin now only.

I think the pathogenesis is like this

• dilation of veins and capillaries due to impaired venous drainage
• passive process
• $\to$ local increase in venous pressure
• pathological
• $\to$ congested tissue, red cell stasis, accumulation of deoxygenated hemoglobin
• $\to$ shortage of oxygen and built-up metabolic waste
• $\to$ bluish skin (cyanotic)
• Causes: venous thrombosis or edema; venous compression; heart failure.

What is the right pathogenesis of chronic venous congestion in skin?

I think CVC cannot lead to heart failure primarily. So let's think its pathogenesis in skin now only.

I think the pathogenesis is like this

• dilation of veins and capillaries due to impaired venous drainage
• reduced outflow of blood from a tissue
• passive process
• $\to$ local increase in venous blood volume
• $\to$ local increase in venous pressure
• pathological
• $\to$ congested tissue, red cell stasis, accumulation of deoxygenated hemoglobin
• $\to$ shortage of oxygen and built-up metabolic waste
• $\to$ dusky reddish-bluish skin (cyanotic)
• Causes: venous thrombosis or edema; venous compression; heart failure.

What is the right pathogenesis of chronic venous congestion in skin?