Avaliação das alterações macro e microcirculatórias dos membros inferiores de mulheres com doença venosa crônica e obesidade, tratadas por escleroterapia com espuma densa, associada ou não ao uso do Pycnogenol®

Abstract

Chronic venous disease (CVD) is a quite prevalent multifactorial, chronic and progressive disease, with low mortality and high morbidity. At more advanced levels, both macro and microcirculation are seriously impaired. One of the risk factors for CVD is obesity, but the pathophysiological mechanism over this association remains unclear. It is known that obesity worsens venous hypertension, in addition to the inflammatory processes triggered by the metabolic syndrome and CVD itself. The objective of this study was to evaluate the macro and microcirculation in women with CVD and obesity, after eco-guided sclerotherapy with dense foam (FGE), evaluating two groups, one with EEED+Pycnogenol® (Pinus pinaster Aiton) (Flebon®) 50 mg TID and the other with EEED+placebo. Post-procedure, the women wore elastic compression stockings for 30 days and took the medication/placebo for 90 days. The microcirculatory parameters evaluated using Microscan® were the functional capillary density (DCF) (number of capillaries with flow per mm2), the dermal papilla diameter (DPD) (quantifies edema), the capillary bulk diameter (DBC) (the largest capillary bulk diameter evaluating the degree of change), capillary diameter (DC) (mean width of the red blood cell column), and capillary morphology (CM) (percentage of the number of capillaries altered to the number of capillaries observed). The macrocirculation parameters evaluated by Echo Color Doppler (ECD) were venous occlusion and reflux improving. The quality of life (QoL) was evaluated through scores and questionnaires. For statistical analysis were used Fischer's exact test, Mann-Whitney U test, Wilcoxon signed-rank test with Bonferroni correction, and Cliff's delta effect size. In the EEED+Pycnogenol® group, there was a significant improvement in functional capillary density (DCF) in the analyzed periods (p <0,007). The CM showed a significant improvement trend in the 30-day comparison (p= 0,0176), which was confirmed in subsequent comparisons (entry vs. 90 days and period measurements: p < 0,008) only for the EEED+Pycnogenol® group. The DPD and DBC showed a reduction after 90 days (p < 0,001) while the CM showed a practically significant improvement (p = 0,053). Still considering these last three parameters, when analyzing the differences in measurements in the three periods, an improvement is observed for all of them, in both groups (p < 0,011). The analysis of the magnitude of effect showed for DCF an average effect by Cliff´s delta of 0,46 and 0,44 (30 and 90 days) and a trend of significance for the parameters DPD and DBC. An improvement in macrocirculation was observed in 80% of the patients after 30 days and in more than 95% after 90 days. There was CEAP regression from C3 to C2 in the EEED+ Placebo group (p < 0,020) and in the EEED+Pycnogenol® group (P < 0,005). The QoL parameters showed a reduction in both groups. It was concluded that FGE is effective in reducing venous hypertension, impacting on clinical, macro and microcirculatory improvement, as well as the QoL of women with obesity and CVD, and that the Pycnogenol® caused positive results in the microcirculation, possibly by reducing inflammation