Oscillatory flow suppression improves inflammation in chronic venous disease.

BACKGROUND: To assess if suppression of the oscillatory component of reflux may improve the inflammatory phenotype in chronic venous disease (CVD).

MATERIALS AND METHODS: From 193 CVD patients, we selected 54 (13 males, 41 females, CEAP C2-4EpAsPr) for a blinded, case-control prospective investigation. All of them underwent echo-color-Doppler assessment of reflux parameters. In the same patients a blood systemic assessment of 19 inflammatory cytokines was obtained. Follow-up lasted 6 months. The control group (C) was constituted by 21 homogenous CVD patients, unselected and not operated.

RESULTS: Thirty-one of 54 patients were excluded from post-operative evaluation in consequence of reported new other inflammatory episodes. Twenty-three (23) completed the follow up, showing the suppression of the oscillatory component of venous reflux; 4 of the 19 cytokines decreased significantly after the procedure: Tumor Necrosis Factor-α (TNFα), Granulocyte Colony Stimulating Factor (G-CSF), Interferon gamma-induced Protein 10 (IP-10), Interleukin-15 (IL-15). Particularly, TNFα and IP-10 even returned inside a physiological range: 5.3 ± 2.7 to 4.2 ± 2.2 pg/mL (P < 0.003) and from 303.7 ± 168.4 to 254.0 ± 151.6 pg/mL (P < 0.024), respectively. Both cytokines showed a weak but significant correlation with parameters of oscillatory flow correction. Finally, three cytokines implicated in repair and remodeling of tissue, Epidermal Growth Factor, Monocyte Chemoattractant Protein-1 and Platelet Derived Growth Factor-BB (PDGF-BB), significantly increased. Our findings are further reinforced by the significant changes of the same cytokines when compared to C group.

CONCLUSIONS: The surgical suppression of the oscillatory component of reflux modulates the inflammatory phenotype, suggesting a pivotal role of flow among factors concurring to inflammation in CVD.