Avaliação comparativa da microcirculação em pacientes C0a e C0s

Abstract

Chronic Venous Disease (CVD) is an abnormality on the venous system function caused by venous hypertension due to venous reflux, obstruction of the venous flow or both affecting the superficial or deep venous system or both. Microcirculatory impairment caused by chronic venous hypertension is usually not taken into account in chronic venous insufficiency, probably due to lack of practical way to observe it. The objective of this work is to use a noninvasive technique to access quantitatively the cutaneous microangiopathy in female patients classified according to CEAP C0s (C zero symptomatic) and matched with healthy controls C0a (C zero assymptomatic). Microcirculatory impairment caused by chronic venous hypertension is one of the earliest signs of CVD. Cutaneous capillaries progressively enlarged and tortuous, forming bulks or skeins described in the literature as glomerulus like capillaries. Several methods have been used to assess the degree of CVD, as Venous Clinic Severity Score (VCSS), Air plethysmography and Eco Color Doppler, however none of them showed reliable stratification related to CEAP classes or was used successfully to demonstrate possible differences in earlier stages of the disease. Patients were eligible if they were between 18 and 35 years, diagnosis of CVD (CEAP C0a and C0s), and Fitzpatrick 1 through 4. We have analyzed transversely a total of 44 patients with CVD, CEAP C0a and C0s. Eco Color Doppler examination of the lower limbs were performed in the morning and afternoon with ultrasound Doppler. The VCSS form was filled in and CytoCam (IDF) exame helded in the morning. The diameter of the dermal papilla (p=0.01) and the functional capillary density (p=0.03) were the parameters that changed earlier in CVI with statistic difference from C0a compared to C0s. These findings represent a hypertrophy of the dermal papilla found in initial subclinical edema. We have concluded that it is possible to objectively grade the microangiopathy in CVI with CytoCam. Two parameters were the most important to identify differences between C0a and C0s at initial stages of CVI: diameter of dermal papilla and functional capillary density. We suggest a Microcirculatory patern in microangiopathy findings which presented good correlation with CEAP. The third-generation handheld microscope utilising Incident Dark Field (IDF) illumination is a practical and efficient method for image acquisition of cutaneous microcirculation and its remodeling in early stages of CVD.