RED-CELL AGGREGABILITY INCREASES WITH THE SEVERITY OF VENOUS INSUFFICIENCY

Several studies have suggested the presence of hemorheological abnorma lities in venous insufficiency. The present prospective study was carr ied out to determine whether the increase in hemorheological disturban ces parallels the evolution of the disease. Patients were recruited am ong ambulant outpatients and classified in 3 evolution stages of venou s insufficiency according to the clinical and functional examination. Once a certain number of patients were included, the following success ive inclusions were made in order to match for age and sex, in the oth er stages of venous insufficiency, the previously included patients. S ince blood theology is frequently altered in hypertension, diabetes an d several other vascular pathologies, patients with those pathologies were not included. Sixty nine patients with venous insufficiency and 2 3 healthy subjects were tested, making up twenty three matching sets. Red blood cell (RBC) aggregation and disaggregation were assessed with the SEFAM erythroaggregameter on blood samples adjusted to 40% hemato crit. Statistical analysis showed a significant difference for the agg regation index (p=0.0001), disaggregation shear rate (p=0.0001) and fi brinogen (p=0.006) between the 4 groups. Aggregability parameters incr eased gradually with the evolution of the disease, while the fibrinoge n rise was significant only when varicose-veins were present (stages 2 and 3). This progressive rise in RBC aggregability with the aggravati on of venous insufficiency, by superimposing to the haemodynamic defic it, is likely to induce the formation of RBC aggregates in vivo, to pe rpetuate venous stasis and to contribute to the development of severe skin damages.