Irvine3 Circulation Sciences, G. D'Annunzio University, Pescara, Italy -
Irvine3 Circulation Sciences, G. D'Annunzio University, Pescara, Italy.
Minerva Surg. 2023 Dec;78(6):651-656. doi: 10.23736/S2724-5691.23.09935-5. Epub 2023 Aug 3.
The aim of this ex-vivo study was to evaluate the efficacy of Pycnogenol-Centellicum oral supplementation on vein segments, retrieved from graft harvesting or from vein surgery. The parameters assessed were elasticity and recovery after dynamic tests: 1) an enlargement stress; 2) an elongation stress; and 3) elasticity after torsion. The tests were made in standardized conditions, less than 3 hours after explant, at 22 °C by the same operator with surgical and microsurgical experience.
Veins of 59 subjects were included in the study: 17 subjects with normal veins with a planned bypass graft and 42 subjects with varicose veins. Of the subjects with normal veins, 8 subjects followed standard management (group 1) and 9 took Pycnogenol-Centellicum for 4 weeks before surgery (group 2). In the group with varicose veins, 22 subjects served as controls (group 3) and 20 were supplemented with Pycnogenol-Centellicum for 4 weeks before surgery (group 4). No side effects or tolerability problems were observed in the supplementation period before surgery and veins harvesting. The full return to initial shape/sizes after dynamic stress was evaluated in 1 min after removing the stress.
In group 1, 4 out of 8 vein segments recovered their size after forced enlargement vs. 7/9 in the Pycnogenol-Centellicum group 2 (P<0.05). In the elongation test, 3/8 normal control vein segments recovered their length (group 1) vs. 7/9 in the supplement group (group 2) (P<0.05). In the torsion test, 4/8 (group 1) veins recovered their shape after torsion vs. 9/9 veins in Pycnogenol-Centellicum-pretreated segments (group 2) (P<0.05). Only 45.8% of normal, control vein segments (group 1) recovered their shape/size in comparison with 85.2% of normal vein segments in the supplement group (group 2) (P<0.05). In group 3 and 4 (segments of varicose veins), the proportion of vein segments with enlargements, elongation and torsion were significantly lower at the end of the test (P<0.05) in the Pycnogenol-Centellicum group 4 with 51.7% of the vein segments recovering their shape in the Pycnogenol-Centellicum vs. 16.6% of the vein segments recovering their shape in control segments (P<0.05). Results show that Pycnogenol-Centellicum supplementation allows vein segments to better return to their original shape/size after a morphological alteration of shape (in different directions). This could be an expression of an improved wall tone and elasticity of the veins. No vein was teared or damaged during the 59 tests indicating that all stresses were well within the normal wall tensile characteristics of the veins.
In this study, Pycnogenol-Centellicum improved vein elasticity in subjects with normal and varicose veins as vein segments were more elastic (able to recover length and shape) and less passively dilated by high pressure or dynamic stresses. This study indicates that the protective effects of Pycnogenol-Centellicum may partially stop passive dilatation of veins to varicose veins over time by improving vein elasticity. Pycnogenol-Centellicum managed vein segments return more rapidly back to the initial dimensions, shapes and diameters after a dynamic stress.
本体外研究旨在评估碧萝芷-积雪草口服补充剂对取自移植物采集或静脉手术的静脉段的疗效。评估的参数是弹性和动态测试后的恢复情况：1）扩张压力；2）伸长压力；和 3）扭转后的弹性。在 22°C 的标准条件下，由具有手术和显微外科经验的同一位操作人员在取出后 3 小时内进行测试。
将 59 名受试者的静脉纳入研究：17 名受试者为计划旁路移植的正常静脉，42 名受试者为静脉曲张。在正常静脉的受试者中，8 名受试者遵循标准管理（组 1），9 名受试者在手术前服用碧萝芷-积雪草 4 周（组 2）。在静脉曲张组中，22 名受试者作为对照组（组 3），20 名受试者在手术前服用碧萝芷-积雪草 4 周（组 4）。在手术和静脉采集前的补充期间，未观察到任何副作用或耐受性问题。在去除压力后的 1 分钟内评估静脉在动态压力后完全恢复初始形状/尺寸的情况。
在组 1 中，4/8 段静脉在强制扩张后恢复其大小，而在碧萝芷-积雪草组 2 中为 7/9（P<0.05）。在伸长试验中，3/8 个正常对照组静脉恢复其长度（组 1），而补充组（组 2）中为 7/9（P<0.05）。在扭转试验中，4/8（组 1）的静脉在扭转后恢复其形状，而碧萝芷-积雪草预处理段中的 9/9 静脉（组 2）（P<0.05）。与补充组（组 2）中 85.2%的正常静脉段相比，正常对照组（组 1）中只有 45.8%的正常静脉段恢复其形状/尺寸（P<0.05）。在组 3 和 4（静脉曲张静脉段）中，在测试结束时，碧萝芷-积雪草组 4 中静脉段的扩张、伸长和扭转比例明显降低（P<0.05），与对照组相比，碧萝芷-积雪草组中 51.7%的静脉段恢复了其形状，而对照组中 16.6%的静脉段恢复了其形状（P<0.05）。结果表明，碧萝芷-积雪草补充剂允许静脉段在形状发生形态改变后更好地恢复到原始形状/尺寸（在不同方向上）。这可能是静脉壁张力和弹性增强的表现。在 59 次测试中，没有静脉撕裂或损坏，表明所有压力都在静脉壁正常拉伸特性范围内。
在这项研究中，碧萝芷-积雪草改善了正常和静脉曲张患者的静脉弹性，因为静脉段更具弹性（能够恢复长度和形状），并且在高压或动态压力下被动扩张程度较低。这项研究表明，碧萝芷-积雪草的保护作用可能会通过改善静脉弹性，随着时间的推移部分阻止静脉向静脉曲张的被动扩张。碧萝芷-积雪草管理的静脉段在经受动态压力后能更快地恢复到初始尺寸、形状和直径。
