Comparação dos parâmetros macro e microcirculatórios entre a utilização três e por cinco dias da meia elástica de compressão gradual após escleroterapia com espuma densa da veia safena magna

Abstract

Chronic Venous Disease (CVD) of the lower limbs is an abnormality on the venous system function due to, in the majority of cases, venous reflux, obstruction of the flow or both affecting the superficial or deep venous system of the inferior limbs which may cause venous hipertension that leads to the primary symptons of this patology. Foam sclerotherapy is one of the most frequent types of treatment used by vascular surgeons, and is usually followed by the use of graduated compression stockings. Nonetheless there is no clinical consensus on the type of compression, pressure value or its duration. The objective of this research was to identify whether different regimens of graduated compression stockings (GCS) cause significant variations in the large circulatory system and the microcirculation, in the symptoms, in the physical exam and in the patient’s quality of life. Thirty-four women and forty inferior limbs were selected for the study between 2019 and 2020. The limbs were divided into two groups, one using the stockings uninterrupted for three consecutive days and the other for five consecutive days immediately after foam sclerotherapy of the great saphenous vein and keeping the same GCS daily until 30 days after the procedure. The patients were evaluated four times: before the procedure, 15 days, 30 days and 180 days after the sclerotherapy. Pain assessment: a) complaints of limb swelling; b) quality of life questionnaire; c) VCSS Score; d) identification of edema on physical exam; e) microcirculatory; f) Vascular ultrasound classification; g) were performed on each visit. Presence of pain and swelling and the VCSS were significantly improved within the groups, however no statistic significant differences were observed between the variation of each group. Under the vascular ultrasound assessment we suggest a new classification regarding the presence or absence of reflux and occlusion, and the reduction of calibers divided in categories varying from 0 (no response) to 6 (total occlusion of the vein). This assessment of the saphenous vein was divided in thigh-knee and calf segments. All patients had reduction of the saphenous vein on the thigh-knee section in both groups and only one in each group did not have a reduction of caliber on the calf section. The statistical analysis pointed significant differences between the groups of three and five-days of GCS use on the response to sclerotherapy on the calf section, with p-value of 0,03. There was no significant difference between de groups in the microcirculatory parameters or quality of life questionnaire. The variables were compared within each group in relation to visits and between groups. Thereby, we concluded that there was a significant better response in the ecographic evaluation to the use of compression therapy on the calf segment for longer periods after foam sclerotherapy, with better response on the 5-days group. More studies should be performed with more patients to verify the variation of the other parameters.