Use of microcirculatory parameters to evaluate chronic venous insufficiency

BackgroundMicrocirculatory impairment caused by chronic venous hypertension is usually not taken into account in chronic venous insufficiency, probably due to lack of practical means to observe it. The objective of this work was to use a new noninvasive technique to access quantitatively the cutaneous microangiopathy in female patients classified according to CEAP from C1 to C5 and matched with healthy controls.MethodsForty-four patients and 13 healthy subjects (112 lower limbs), with a mean age ± SD of 48 ± 8 years, were evaluated by using orthogonal polarization spectral (OPS) imaging. Films of the internal perimaleolar region were analyzed by the CapImage software. The microcirculatory parameters evaluated were functional capillary density (number of capillaries with flowing red blood cells/mm2), capillary morphology (percentage of abnormal capillaries), diameter (μm) of dermal papilla to quantify edema, diameter of capillary bulk (μm) to assess the degree of change, and diameter capillary limb to detect enlargement. A microcirculatory index combining these five parameters was proposed with I, II, and III stages, indicating normal microcirculation, and moderate and severe microangiopathy, respectively.ResultsThese microcirculatory parameters were significantly different (P < .05) from control values (C): capillary diameter and capillary morphology from C2 to C5, 8.1 ± 0.8, 3.6 ± 5.5 (C), and 9.7 ± 1.3, 27.5 ± 17.7 (C2); diameter of dermal papilla and diameter of capillary bulk from C3 to C5, 111.4 ± 13.5, 52.8 ± 8.8 (C), and 150.5 ± 31.7, 87.8 ± 26.9 (C3); and functional capillary density only from C4 to C5, 20.9 ± 6.1 (C) and 14.5 ± 4.5 (C4). The microcirculatory index showed good correlation to CEAP classification.ConclusionIt was possible to quantify the microangiopathy using OPS imaging and to compare the microcirculatory changes of chronic venous insufficiency patients with healthy controls. Two parameters seemed more important to identify the differences between patients and controls: capillary morphology and capillary diameter. The suggested microcirculatory index can possibly demonstrate, in future studies, a prognostic capability when combined with the CEAP classification.

Clinical RelevanceChronic venous insufficiency is one of the most prevalent diseases in the world, and it still challenges the experts by the great variability of clinical presentations. It is a multifactorial disease that brings great impact in the quality of life of patients because of its trophic lesions, skin ulcerations, pain and work incapacity. A microcirculatory index has been created with I, II and III stages indicating normal microcirculation, moderate and severe microangiopathy, respectively to support and help the CEAP classification. The analysis of cutaneous microcirculation with a new technical instrument, Cytoscan, will make possible to evaluate the development of venous disease through this index.