Avaliação das alterações microcirculatórias dos membros inferiores de portadores de doença venosa crônica tratados por escleroterapia com espuma, associada ou não a fração de flavonóide purificada e micronizada: estudo randomizado, duplo-cego, controlado

Abstract

Chronic venous disease (CVD) is a chronic pathology with an unfavorable development when treated and/or followed up incorrectly. Its treatment varies according to the stage of the disease, ranging from conservative measures to invasive techniques. In addition to macroscopic venous changes, CVD also causes changes in microcirculation. Based on these hypotheses, a non-invasive test to quantify the evolution of microangiopathy may be useful to assess the effects and benefits of treatment. Fifty women, CEAP classification (clinical, etiology, anatomy and pathophysiology) C2 and C3, body mass index (BMI) <30 Kg/m2, without other reported disease, but with incompetent saphenous veins, were evaluated. Varicose veins were treated by ultrasound-guided sclerotherapy with 3% polidocanol foam. Patients were distributed into 2 groups: sclerotherapy + Micronized purified flavonoid fraction (MPFF; Daflon® 1000) group (n=26) and sclerotherapy + placebo group (n=24). Microcirculatory parameters, ultrasound progression, venous clinic and VCSS score (venous clinical severity score) were evaluated pre- and post-treatment. In both analysed groups, there was an improvement in the VCSS score and microcirculation, except for the number of pathological capillaries. Comparing the results between the groups, an expressive reduction in the diameter of the dermal papilla was observed in the MPFF group (p-value=0.053), which, despite not being statistically significant, had an effect size of 0.55 (-0.01 – 1.10), considered medium. In addition, capillary bulk and capillary limb diameters also decreased expressively in the MPFF group. Differences were also observed in the degree of pain 30 days after sclerotherapy between the groups, where the MPFF group reported less pain compared to the placebo group (p-value=0.013). Foam sclerotherapy treatment of the trunk veins proved to be a safe method and, by reducing distal venous hypertension, improved the microcirculation in all patients evaluated, helping to control the disease. In addition, there was an improvement in venous symptoms and edema. The association of a venotonic drug provided benefits by reducing post-procedure pain and greater improvement in microcirculatory parameters