INCREASED PLASMA VASCULAR ENDOTHELIAL GROWTH-FACTOR AMONG PATIENTS WITH CHRONIC VENOUS DISEASE

Skin damage in the presence of chronic venous disease is partially med iated through leukocytes. The endothelium is activated and exhibits pr oliferation in the skin. Up-regulation of vascular endothelial growth factor (VEGF) expression in the skin of patients with chronic venous d isease has been demonstrated with immunohistologic techniques. Abnorma l VEGF expression can have local deleterious effects. The aim of this study was to determine whether patients with chronic venous disease ha ve elevated plasma levels of VEGF. We conducted a prospective study wi th 30 patients with varicose veins of clinical, etiologic, anatomic, a nd pathologic class C3 (normal skin, n = 15) and C4 (trophic skin chan ges, It = 15) and 25 control subjects with no clinical evidence of ven ous or arterial disease of the lower limb. Blood samples were collecte d from a foot vein of each subject before and after a period of experi mental venous hypertension produced by means of standing. Assay of VEG F protein was performed with a sandwich enzyme-linked immunosorbent as say. Plasma VEGF level was elevated in both groups of patients with ve nous disease compared with the control group. The median VEGF levels a mong patients were 81 pg/mL (interquartile range [IQR] 56 to 122) supi ne and 98 pg/mL, (IQR 63 to 153) after standing for 30 minutes. Median VEGF levels among control subjects were 52 pg/mL (IQR 35 to 71) lying supine and 60 pg/mL (IQR 39 to 105) after standing for 30 minutes. Ex perimental venous hypertension caused a small rise in VEGF levels amon g the patients but not the control subjects, further studies are requi red to determine whether increased VEGF expression contributes to tiss ue injury in chronic venous disease.