Ca2+-Dependent Venous Contraction by the Saponoside Escin in Rat Inferior Vena Cava: Implications in Venotonic Treatment of Varicose Veins

Aim This study examines respiratory biometry of inferior vena cava in patients with varicose veins of lower extremities. Material and Methods We performed retrospective analysis of clinical and ultrasound data of 67 patients with primary varicose veins. Results The largest expiratory (mean 16.2 mm, p-value 0.09) and inspiratory (mean 8.2 mm, p-value 0.02) inferior vena cava diameters were in C3 Clinical Etiological Anatomical Pathophysiological clinical class; the smallest expiratory diameters (mean 13.1 mm, p-value 0.5) were in C6 class; the smallest inspiratory diameters (mean 4.6 mm, intercept) were in C2 class. C2 class was associated with highest inferior vena cava collapsibility index (mean 68.2%, intercept); C6 class was associated with lowest collapsibility index (mean 48.3%, p-value 0.04). Recurrent varices in comparison with previously untreated were associated with smaller inspiratory diameters of inferior vena cava (mean 4.4 mm, p-value 0.005), smaller expiratory diameters (mean 13.4 mm, p-value 0.06) and higher collapsibility index (mean 68.5%, p-value 0.005). Patients with recurrent and bilateral varicose veins had identical respiratory biometry of inferior vena cava. Older age was associated with smaller inferior vena cava diameters (p-value <0.01). Conclusion Clinical presentation of varicose veins is associated with different respiratory biometry of suprarenal inferior vena cava. C6 clinical class in comparison with C2 clinical class is associated with lower central venous compliance possible due to the narrowing of inferior vena cava. Smaller inferior vena cava diameters and higher collapsibility index in recurrent subgroup in comparison with previously untreated can be a sign of the significantly altered pressure gradient between the systemic capillaries and the right heart and impaired peripheral venous return. Narrowing of inferior vena cava with age can be a sign of more profound changes in systemic venous return with age in patients with varicose veins in comparison to those without chronic venous disease.

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Popliteal Venous Aneurysm and Multiple Lower Extremity Varicose Veins Presenting with a Left-Sided Inferior Vena Cava

Annals of Vascular Surgery ◽

10.1016/j.avsg.2017.06.143 ◽

2018 ◽

Vol 46 ◽

pp. 367.e7-367.e10

Author(s):

Masaya Nakashima ◽

Masayoshi Kobayashi

Keyword(s):

Inferior Vena Cava ◽

Lower Extremity ◽

Inferior Vena ◽

Varicose Veins ◽

Vena Cava ◽

Venous Aneurysm

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Varicose veins: Look before you strip – the occluded inferior vena cava and other lurking pathologies

South African Medical Journal ◽

10.7196/samj.8395 ◽

2014 ◽

Vol 104 (10) ◽

pp. 668

Author(s):

Taole Mokoena

Keyword(s):

Inferior Vena Cava ◽

Inferior Vena ◽

Varicose Veins ◽

Vena Cava

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A CASE OF SUDDEN DEATH FROM EMBOLISM IN THE INFERIOR VENA CAVA, IN CONNEXION WITH VARICOSE VEINS OF THE LEG.

The Lancet ◽

10.1016/s0140-6736(02)49011-3 ◽

1874 ◽

Vol 103 (2652) ◽

pp. 901-902

Author(s):

Thomas Browne

Keyword(s):

Sudden Death ◽

Inferior Vena Cava ◽

Inferior Vena ◽

Varicose Veins ◽

Vena Cava

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Horseshoes Are Not Always Lucky: A Rare Cause of Varicose Veins

Journal for Vascular Ultrasound ◽

10.1177/154431670903300108 ◽

2009 ◽

Vol 33 (1) ◽

pp. 36-39

Author(s):

Kathryn Busch ◽

Judith Doyle ◽

Martin Forbes ◽

Geoffrey White ◽

John Harris ◽

...

Keyword(s):

Inferior Vena Cava ◽

Inferior Vena ◽

Varicose Veins ◽

Vena Cava ◽

Horseshoe Kidney ◽

Duplex Ultrasound ◽

Iliac Vein ◽

Venous Hypertension ◽

Common Iliac Vein ◽

True Nature

Introduction Color duplex ultrasound (CDU) assessment for patients with varicose veins has increased in prevalence as new techniques for treatment continue to emerge. Occasionally, patients present with atypical varicosities that warrant the typical study to be extended to unveil the true underlying cause of the condition. Clinical Details A 41 year old man presented to our laboratory for assessment of bilateral varicose veins. He had recently developed venous eczema. Examination of the patient revealed large varicose veins associated with the long saphenous system, especially prominent on the left side. Methods Using a standard venous incompetence study protocol, CDU was performed with a Philips IU22 machine. The lower-extremity deep and superficial venous systems were assessed for patency and competency. Measurements of incompetent venous junctions and noteworthy vessel diameters were included. The examination was extended to include the pelvic and abdominal veins on the basis of unusual findings during the CDU imaging of the legs. Results Superficial venous insufficiency was detected involving the saphenofemoral junctions (SFJs), long saphenous veins (LSVs), and tributaries bilaterally. Bilateral incompetent calf perforators were identified. On the left, two large SFJs were identified and the LSV measured up to 2.1 cm in diameter. On both sides, an incompetent superficial pelvic vein arising from the SFJ was identified tracking proximally. Examination of the iliac veins revealed normal right iliac veins. On the left, the common iliac vein was extrinsically compressed as was the inferior vena cava. Further examination revealed a horseshoe kidney. The confluence of the lower poles of the kidneys were anterior to the aorta, inferior vena cava, and left common iliac vein, compressing the venous vasculature, accounting for the venous hypertension and left sided prominence. Further management included confirmatory radiological imaging and intervention. Conclusion Atypical varicose veins may be a result of a plethora of causes. It is crucial to the patient's outcome to reveal the true nature of the underlying cause. Abdominal sources of venous incompetence need appropriately tailored intervention to prevent recurrence and potential worsening of symptoms.

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Reno-iliac intrasystem anastomoses of the inferior vena cava

Andrology and Genital Surgery ◽

10.17650/2070-9781-2020-21-2-51-57 ◽

2020 ◽

Vol 21 (2) ◽

pp. 51-57

Author(s):

A. A. Kapto

Keyword(s):

Inferior Vena Cava ◽

Collateral Circulation ◽

Inferior Vena ◽

Varicose Veins ◽

Left Renal Vein ◽

Vena Cava ◽

Nutcracker Syndrome ◽

Study Objective ◽

Testicular Vein ◽

X Ray

The study objective is to describe the anastomoses between the left renal and iliac veins in the inferior vena cava system and to classify these anastomoses.Materials and methods. From 2015 to 2020, 340 men with varicose veins of the pelvic organs and bilateral varicocele were examined. Delayed imaging for 10–30 s with phlebotesticulography of 157 patients allowed us to study in more detail the vascular venous x-ray anatomy of the scrotum and various options for collateral circulation.Results. The data obtained by us during phlebography allowed us to offer our own classification of anastomoses between the left renal vein and the common iliac vein in the inferior vena cava system (reno-iliac intrasystemic anastomoses of the inferior vena cava): 1) through the vein of the vas deferens (v. ductus deferens), 2) through the cremasteric vein (v. cremasterica), 3) through the external testicular vein (v. testicularis externa). In addition to the classification, the terms for specific types of anastomoses are also proposed by us for the first time and do not have a name in the medical scientific literature. A new definition of the term “venous anastomotic node (nodus venarum anastomoticus) of the testis and its appendage” is proposed, which describes the anatomical relationship between the 4 veins: the internal testicular vein, external testicular vein, vena cremasterica and veins of the vas deferens. A new term is proposed “pseudo-varicocele” that defines the compensatory expansion of the internal testicular vein during normal antegrade blood flow through it.Conclusion. In this work, we give an X-ray anatomical description of the development of various types of collateral circulation in the system of the inferior vena cava between the left renal vein and iliac vessels in various types of arteriovenous conflicts of both the upper (nutcracker syndrome, posterior nutcracker syndrome) and the lower level (May–Thurner syndrome).

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Sex-related decrease in [Ca2+]i signaling and Ca2+-dependent contraction in inferior vena cava of female rat

AJP Regulatory Integrative and Comparative Physiology ◽

10.1152/ajpregu.00465.2009 ◽

2010 ◽

Vol 298 (1) ◽

pp. R15-R24 ◽

Cited By ~ 6

Author(s):

Yin Xia ◽

Raouf A. Khalil

Keyword(s):

Inferior Vena Cava ◽

Inferior Vena ◽

Varicose Veins ◽

Vena Cava ◽

Free Calcium ◽

Female Rat ◽

Sprague Dawley ◽

Male And Female ◽

Venous Function ◽

The Right

Sex differences in the incidence of varicose veins have been suggested; however, the venous mechanisms involved are unclear. We hypothesized sex-related differences in venous function and underlying distinctions in intracellular free calcium, [Ca2+]i, signaling and Ca2+-dependent mechanisms of venous contraction. Circular segments of inferior vena cava (IVC) from male and female Sprague-Dawley rats were suspended between two hooks, labeled with fura-2, and placed in a cuvet inside a spectrofluorometer for simultaneous measurement of isometric contraction and the 340/380 fluorescence ratio (indicative of [Ca2+]i). In male IVC, phenylephrine (PHE; 10−5 M) caused significant increase in contraction and [Ca2+]i. In female IVC, PHE-induced contraction was significantly reduced, but [Ca2+]i did not differ significantly from males. Membrane depolarization by KCl (96 mM), which stimulates Ca2+ influx, caused parallel increases in contraction and [Ca2+]i in male IVC, and the KCl-induced contraction was significantly reduced in parallel with [Ca2+]i in female IVC. In male IVC stimulated with 0 Ca2+ KCl solution, the addition of increasing concentrations of extracellular Ca2+ ([Ca2+]e) (0.1, 0.3, 0.6, 1, and 2.5 mM) caused stepwise increases in contraction and [Ca2+]i, and both the KCl-induced [Ca2+]e-contraction curve and the [Ca2+]e-[Ca2+]i curve were reduced in female IVC, suggesting reduced Ca2+ entry via voltage-gated channels. The PHE-induced [Ca2+]e-contraction curve was significantly reduced in females, but the [Ca2+]e-[Ca2+]i curve was similar in female and male IVC, suggesting the involvement of other mechanisms in addition to Ca2+ entry. The [Ca2+]e-contraction and [Ca2+]e-[Ca2+]i curves were used to construct the [Ca2+]i-contraction relationship. The KCl-induced [Ca2+]i-contraction relationship was superimposed in male and female IVC. In contrast, the PHE-induced [Ca2+]i-contraction relationship was reduced and located to the right in female compared with male IVC, suggesting reduced [Ca2+]i sensitivity of the venous contractile myofilaments. The reduced contraction, [Ca2+]i, and [Ca2+]i sensitivity in female veins render them more prone to dilation. These sex-specific reductions in venous function, if they also occur in human veins, may play a role in the greater incidence of varicose veins in females.

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