Relationship of plasma vascular endothelial growth factor to CEAP clinical stage and symptoms in patients with chronic venous disease

Objective. Skin damage caused by chronic venous disease (CVD) is associated with severe microangiopathic changes in the skin. The aim was to determine whether patients in various CEAP clinical stages of CVD have elevated plasma levels of VEGF compared to controls and whether this correlates with the symptoms. Methods. One hundred and eight patients with CVD attending the vascular clinic were included and assigned to the appropriate CEAP clinical stage. Thirty healthy control subjects were also included. Patients and controls were studied after resting supine for 10 min. Blood samples were taken from a dorsal foot vein. Assay of VEGF was performed with an enzyme-linked immunosorbent assay. Volunteers' symptoms were recorded using a visual analogue scale (VAS) for heaviness, cramps, paraesthesiae and swelling. Results. Plasma levels of VEGF were: control (n30) median VEGF 56 pg/ml (inter-quartile range IQR 38-85), CEAP C2 (varicose veins) 86 (39-133), C5 (healed ulcer) 88 (67-135). Median difference: control vs. C5 33 (95% confidence interval (CI) 8-61). Median differences were calculated using the Wilcoxon method. VEGF level in patients with VAS swelling score = 0:54 pg/ml (IQR 31-104). VEGF level in patients with VAS swelling score > 0:85 pg/ml (IQR 40-147). Difference between medians: 20 ng/ml, 95% CI for the median difference: (5-44). No differences were observed for symptoms of heaviness, cramps or paraesthesiae. Conclusion. There was a trend towards raised VEGF in all stages of CVD, but this only reached statistical significance in those with healed ulceration. The symptom of swelling was associated with raised VEGF levels; however, the symptoms of heaviness, cramps, and paraesthesiae were not associated with raised VEGF levels.