Results and Significance of Colour Duplex Assessment of the Deep Venous System in Recurrent Varicose Veins

Objective: An evaluation of the treatment of patients with venous angiodysplasia and severe chronic insufficiency. Design: The clinical series of patients with venous angiodysplasia of Klippel-Trenaunay (K-T) and Servelle-Martorell (S-M) type. Setting: Primary care teaching hospital. Patients: Eighty-three patients with angiodysplasia type K-T characterized by the triad of local giantism, varicose veins and naevus flammeus. Malformations of the deep venous system were present in 96%. The predominant vascular lesion in patients with the S-M syndrome ( n=34) was a haemangiomatosis, involving both the skeleton and soft tissues, causing growth retardation in the affected extremity. A malformation of the deep venous system could be seen in all patients. Main outcome measures: Healing of skin ulcers and varicose bleeding of the lower extremities. Interventions: Conservative treatments included external compression bandages or stockings. In 14 patients, surgical extirpation of superficial veins was used. Results: All the ulcers were treated successfully, and no haemorrhage reoccurred. Haemodynamic studies showed an improvement of the venous reflux disease in 86% of patients. Conclusion: Venous angiodysplasia of the lower extremity is nearly always associated with malformation of the deep venous system. Surgery is indicated for the elimination of a pathological short circuit flow in atypical drainage veins of the affected leg, especially when skin lesions are present. For any type of surgery, a careful preoperative angiographic and haemodynamic evaluation is mandatory.

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The value of thermography in the preoperative mapping of primary and recurrent varicose veins

Phlebologie ◽

10.1055/s-0037-1617333 ◽

2000 ◽

Vol 29 (05) ◽

pp. 129-133

Author(s):

G. Madycki ◽

J. Grzegrzólka ◽

W. Hendiger ◽

W. Staszkiewicz

Keyword(s):

Sensitivity And Specificity ◽

Varicose Veins ◽

Preoperative Evaluation ◽

Duplex Ultrasound ◽

Preoperative Assessment ◽

Venous System ◽

Quick Method ◽

Simple Method ◽

Recurrent Varicose Veins ◽

Preoperative Mapping

SummaryAim: Despite great advances in ultrasound diagnosis of the venous system, there is still a need for a quick and simple method of complex preoperative visualisation of the superficial venous system and its incompetent perforators. The aim of the study was to assess the usefullness of thermography in the preoperative mapping of the superficial venous system among patients with primary and recurrent varicose veins. Method: Authors examined prospectively 48 patients with varicose veins (36 with primary and 12 with recurrent varicose veins). Preoperative assessment was performed by means of infrared scanning (thermography). The results were verified by colour coded duplex ultrasound and intraoperative findings. In the results, the mapping of incompetent veins by thermography unit showed an excellent correlation with colour/duplex scan and intraoperative findings. The sensitivity and specificity for thermography were 85.4% and 93.7% respectively and were lower than the values acquired by US scanning (sensitivity and specificity – 89.6% and 97.7% respectively). Conclusion: Authors conclude, that colour/duplex ultrasound remains a method of choice in the preoperative evaluation of the entire venous system, but thermography offers a simple and quick method for complex mapping of the incompetent superficial venous system. This method might prove to be a helpful adjunct to the ultrasound, particularly in case of recurrent varicose veins or in cases, when the incompetent veins are not well seen (e. g. obesity).

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PATHOPHYSIOLOGICAL AND PATHOMORPHOLOGICAL ASPECTS OF RELAPSE OF VARICOSE VEINS AFTER ENDOVASCULAR LASER VEIN COAGULATION

Wiadomości Lekarskie ◽

10.36740/wlek202011124 ◽

2020 ◽

Vol 73 (11) ◽

pp. 2468-2475

Author(s):

Volodymyr B. Goshchynsky ◽

Bogdan O. Migenko ◽

Svitlana S. Riabokon

Keyword(s):

Endothelial Dysfunction ◽

Postoperative Period ◽

Varicose Vein ◽

Varicose Veins ◽

Lower Extremities ◽

Venous System ◽

Circulating Endothelial Cells ◽

Electron Microscopic ◽

Deep Venous System ◽

Vein Disease

The aim: With the help of biochemical and morphological methods of investigation to identify the causes of a false postoperative recurrence of varicose veins after the EVLC. Materials and methods: In 173 patients with varicose veins of the lower extremities, the level of markers of endothelial dysfunction was determined: P-selectin, E-selectin, tissue plasminogen activator, endothelin-1, adhesion molecules of type 1 vascular endothelium (sVCAM-1-soluble vascularcellularmolecula), circulating endothelial cells (CEC) before surgery (EVLC), on the 10th and 60th day of the postoperative period.At the same time, a morphological and electron microscopic examination of the state of the deep venous system in 31 patients with varicose vein disease of the lower extremities who died from acute heart failure, was performed. Results: Increased values of markers of endothelial dysfunction in patients with varicose veins of the lower extremitiesbefore surgery of EVLC were established. We found that, despite the operation, the parameters of endothelial dysfunction decrease, but in the remote postoperative period do not come to the norm. Morphological and electron microscopic studies of the deep vein wall revealed pathomorphological changes in all of their layers, especially the endothelial layer. At the heart of the development of endothelial dysfunction in the postoperative period, the leading role belongs to changes in mitochondria. Conclusions: 1. Based on our research, we can state that there are significant pathomorphological and pathophysiological changes in the deep venous system of the lower extremities in conditions of varicose vein disease. 2. The initiator of postoperative relapse of varicose veins are structural changes in the wall of deep veins with a violation of the integrity of the endothelial lining, contributing to the absorption of plasma and leukocyte contents from the blood stream in the interstitium, with the following pathological changes in the layers of deep veins.Such changes are the basis for the manifestations of endothelial dysfunction in the postoperative period.

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Recurrent varicose veins below the knee after varicose vein surgery

Phlebologie ◽

10.1055/s-0037-1622175 ◽

2007 ◽

Vol 36 (03) ◽

pp. 132-136

Author(s):

M. W. de Haan ◽

J. C. J. M. Veraart ◽

H. A. M. Neumann ◽

P. A. F. A. van Neer

Keyword(s):

Varicose Vein ◽

Varicose Veins ◽

Varicose Vein Surgery ◽

Proximal Point ◽

Perforating Veins ◽

Recurrent Varicose Veins ◽

Below The Knee ◽

Duplex Imaging ◽

Additional Value

SummaryThe objectives of this observational study were to investigate whether varicography has additional value to CFDI in clarifying the nature and source of recurrent varicose veins below the knee after varicose vein surgery and to investigate the possible role of incompetent perforating veins (IPV) in these recurrent varicose veins. Patients, material, methods: 24 limbs (21 patients) were included. All patients were assessed by a preoperative clinical examination and CFDI (colour flow duplex imaging). Re-evaluation (clinical and CFDI) was done two years after surgery and varicography was performed. Primary endpoint of the study was the varicographic pattern of these visible varicose veins. Secondary endpoint was the connection between these varicose veins and incompetent perforating veins. Results: In 18 limbs (75%) the varicose veins were part of a network, in six limbs (25%) the varicose vein appeared to be a solitary vein. In three limbs (12.5%) an incompetent sapheno-femoral junction was found on CFDI and on varicography in the same patients. In 10 limbs (41%) the varicose veins showed a connection with the persistent below knee GSV on varicography. In nine of these 10 limbs CFDI also showed reflux of this below knee GSV. In four limbs (16%) the varicose veins showed a connection with the small saphenous vein (SSV). In three limbs this reflux was dtected with CFDI after surgery. An IPV was found to be the proximal point of the varicose vein in six limbs (25%) and half of these IPV were detected with CFDI as well. Conclusion: Varicography has less value than CFDI in detecting the source of reflux in patients with recurrent varicose veins after surgery, except in a few cases where IPV are suspected to play a role and CFDI is unable to detect these IPV.

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Cellular senescence at the saphenofemoral junction in patients with healthy, primary varicose and recurrent varicose veins – A pilot study

Vascular ◽

10.1177/17085381211012882 ◽

2021 ◽

pp. 170853812110128

Author(s):

Dominic Mühlberger ◽

Anne-Katrin Zumholz ◽

Erich Brenner ◽

Achim Mumme ◽

Markus Stücker ◽

...

Keyword(s):

Pilot Study ◽

Cellular Senescence ◽

Varicose Vein ◽

Varicose Veins ◽

Common Finding ◽

Venous Disease ◽

Venous Reflux ◽

Recurrent Varicose Veins ◽

Primary Varicose Veins ◽

Saphenofemoral Junction

Objectives Cellular senescence could play a role in the development of venous disease. Superficial venous reflux at the saphenofemoral junction is a common finding in patients with primary varicose veins. Furthermore, reflux in this essential area is associated with higher clinical stages of the disease and recurrent varicose veins. Therefore, this pilot study aimed to investigate cellular senescence in the immediate area of the saphenofemoral junction in patients with healthy veins, primary varicose veins and additionally in patients with recurrent varicose veins due to a left venous stump. Methods We analyzed vein specimens of the great saphenous vein immediately at the saphenofemoral junction. Healthy veins were collected from patients who underwent arterial bypass reconstructions. Samples with superficial venous reflux derived from patients who received high ligation and stripping or redo-surgery at the groin, respectively. Sections were stained for p53, p21, and p16 as markers for cellular senescence and Ki67 as a proliferation marker. Results A total of 30 samples were examined (10 healthy, 10 primary varicose, and 10 recurrent varicose veins). We detected 2.10% p53+ nuclei in the healthy vein group, 3.12% in the primary varicose vein group and 1.53% in the recurrent varicose vein group, respectively. These differences were statistically significant ( p = 0.021). In the healthy vein group, we found 0.43% p16+ nuclei. In the primary varicose vein group, we found 0.34% p16+ nuclei, and in the recurrent varicose vein group, we found 0.74% p16+ nuclei. At the p < 0.05 level, the three groups tended to be significant without reaching statistical significance ( p = 0.085). There was no difference in respect of p21 and Ki67. Conclusion We found significantly higher expression rates of p53 in primary varicose veins at the saphenofemoral junction than in healthy veins. p16 expression tended to be increased in the recurrent varicose vein group. These preliminary findings indicate that cellular senescence may have an impact in the development of varicose veins or recurrence. Further studies addressing this issue are necessary.

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