Microangiopathy in Chronic Venous Insufficiency before and after Sclerotherapy and Compression Treatment: Results of a One-Year Follow-up Study

Abstract

Objective: To characterize microangiopathy in patients with chronic venous insufficiency (CVI) of a moderate to severe stage and to evaluate improvement of the microcirculatory parameters after sclerotherapy of incompetent perforators and compression therapy. Design: Fluorescence videomicroscopy (Na-fluore-scein), laser Doppler fluxmetry and tc Po2 measurements (43°C) at the medial ankle in healthy controls and patients. Laser Doppler flux and tc Po2 were recorded in supine and sitting position in order to evaluate postural vasoconstriction. The measurements were repeated 6 and 12 months after sclerotherapy of incompetent perforators (Polidocanol 40 mg/ml) and compression therapy by below-knee class II or III stockings (Sigvaris®). Setting: Department of Internal Medicine, Angiology Division, University Hospital, Zurich, Switzerland. Patients, participants: 15 healthy subjects (15 legs, mean age 53.3 years) and 15 patients with CVI of a moderate to severe stage (17 legs, mean age 56.8 years). Results: Microangiopathy in CVI is characterized by significantly enlarged, elongated and dilated capillaries with increased diameters of the pericapillary spaces (‘halos’). Single capillaries may be thrombosed. Laser Doppler flux is increased and tc Po2 is decreased. After therapy, there was a trend to decreased laser Doppler flux and an increase in tc Po2, but the differences were not statistically significant. Capillary thromboses were no longer detected. Mean halo diameters tended to decrease, but this difference was not statistically significant. Conclusions: Microangiopathy in CVI is characterized by morphological and functional changes. Beneficial changes induced by therapy develop slowly and emphasize the importance of long-lasting treatment.