Análise da micro, macrocirculação, VEGF-C, uso de instrumentos relativos à qualidade de vida e escalas para avaliação do flebolinfedema e da doença venosa crônica em mulheres, grupos CEAP C₂ e C₃, pré e pós-elastocompressão
https://www.bdtd.uerj.br:8443/handle/1/24551
Chronic venous disease (CVD) is a morbidity with relevant prevalence and phlebolymphedema is the most common type of lymphedema in the western world. The main goal of this research was to analyze the microcirculation, macrocirculation and alterations of plasmatic levels of the protein VEGF-C (Vascular Endothelial Growth Factor C), before and after lower limb compression therapy, on patients with CVD, CEAP C₂ and C₃ groups, without and with edema.
The following tools were included; the Lymph-ICF-LL Questionnaire, the pain evaluation scale (PES), the ISL lymphedema staging and the Venous Clinical Severity Score – Stockings (VCSS-S). This was a prospective monocentric study with intervention, conducted at the Laboratory of Clinical and Experimental Research in Vascular Biology at the State University of Rio de Janeiro (BioVasc, UERJ).
Thirty-four female patients (68 lower limbs) with ages ranging between 26 and 53 years old were included, which consisted of two visits, before (V1) and after (V2) compression treatment (90 days) each one with anamnesis and physical examination, containing the aforementioned tools. The analysis of the microcirculatory parameters (functional capillary density, diameters of dermal papilla (DDP), of capillary bulk (DCB) and capillary diameter (CD)) was conducted using Microscan® or CytoCam® devices and for the macrocirculation (diameter of the great saphenous vein in the saphenofemoral junction, of the great saphenous vein in the distal thigh region, of the great saphenous vein in the distal leg and of the small saphenous vein (DSSV)) and CEAP classification, the venous color Doppler ultrasound of the lower limbs was utilized. Thicknesses (in mm) of the thigh (TT) and leg (TL) were measured. VEGF-C dosage was performed using blood samples.
The results demonstrated that the adherence of compression stockings lasted 65 to 102 days, statistical significance improvement in all microcirculatory parameters except CD, and macrocirculatory parameter (DSSV), PES, VCSS-S and part of the Lymph-ICF-LL in both groups in V2. In relation to C₃ group, the ISL also improved in V2. Subcutaneous proximal TL was lower in C₂, C₃ and cutaneous proximal TL in C₂ in V2. Regarding the plasmatic levels of VEGF-C, there was no statistical difference in relation to the main tests conducted. However, there was a direct and moderate correlation between VEGF-C levels and the DDP and an inverse and moderate correlation between VEGF-C and all lower limb volumes measured (LLVM), VCSS-S and part of the Lymph-ICF-LL for C₂ in V1 and between this protein and all LLVM in C₂ V2. In C₃ V2, the DCB, DSSV and most of the questionnaire Lymph-ICF-LL were also inversely correlated with VEGF-C levels. Another important result was the shift of 26.5% of C₃ to C₂ group.
The results have shown an improvement of micro, macrocirculation, Lymph-ICF-LL, EAD, VCSS-S, ISL and phlebolymphedema in V2. Despite the absence of changes in VEGF-C levels, its correlation with micro, macrocirculation, all LLVM and the Lymph-ICF-LL may indicate a physiological compensatory mechanism related to the control of phlebolymphedema that might also be seen in other CEAP groups. Future studies become necessary, aiming to demonstrate the influence of VEGF-C in the course of CVD and phlebolymphedema.
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