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

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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Symptomatic recurrent varicose veins due to primary avalvular varicose anomalies (PAVA): A previously unreported cause of recurrence

SAGE Open Medical Case Reports ◽

10.1177/2050313x18777166 ◽

2018 ◽

Vol 6 ◽

pp. 2050313X1877716

Author(s):

Alice M Whiteley ◽

Judith M Holdstock ◽

Mark S Whiteley

Keyword(s):

Varicose Veins ◽

Duplex Ultrasonography ◽

Venous Reflux ◽

Recurrent Varicose Veins ◽

Saphenous Veins ◽

Primary Procedure ◽

Previous Trauma ◽

Primary Varicose Veins ◽

Endovenous Treatment ◽

Saphenofemoral Junction

A 56-year-old woman presented in 2006 with symptomatic primary varicose veins in her right leg. Venous duplex ultrasonography at that time showed what appeared to be “neovascular tissue” around the saphenofemoral junction. However, there had been no previous trauma or surgery in this area. This appearance has subsequently been described as primary avalvular varicose anomalies. She underwent endovenous treatment at that time. In 2018, she presented with symptomatic recurrent varicose veins of the same leg. Venous duplex ultrasonography showed successful ablation of the great saphenous and anterior accessory saphenous veins. All of the recurrent venous reflux was arising from the primary avalvular varicose anomalies. This report shows that primary avalvular varicose anomalies is a previously unreported cause of recurrent varicose veins and leads us to suggest that if found, treatment of the primary avalvular varicose anomalies should be considered at the primary procedure.

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Strip-tract revascularization as a source of recurrent venous reflux following high saphenous tie and stripping: results at 5–8 years after surgery

Phlebology The Journal of Venous Disease ◽

10.1177/0268355514535927 ◽

2014 ◽

Vol 30 (8) ◽

pp. 569-572 ◽

Cited By ~ 15

Author(s):

Alexandra E Ostler ◽

Judy M Holdstock ◽

Charmaine C Harrison ◽

Barrie A Price ◽

Mark S Whiteley

Keyword(s):

Response Rate ◽

Great Saphenous Vein ◽

Varicose Veins ◽

Duplex Ultrasonography ◽

Venous Reflux ◽

Primary Varicose Veins ◽

And Inversion ◽

Saphenofemoral Junction ◽

Subfascial Endoscopic Perforator Surgery

Objective We have previously reported strip-tract revascularization 1 year following high saphenous ligation and inversion stripping. This study reports the 5–8 year results in the same cohort. Methods Between 2000 and 2003, 72 patients presented with primary varicose veins and had undergone high saphenous ligation and inversion stripping plus phlebectomies with or without subfascial endoscopic perforator surgery. Of the 64 patients who had attended for follow-up at 1 year, 35 patients (male:female, 16:19; 39 legs) underwent duplex ultrasonography 5–8 years after surgery (response rate 55%). Duplex ultrasonography was performed and all strip-tract revascularization and reflux and groin neovascularization was documented. Results Eighty-two percent of legs of patients showed some evidence of strip-tract revascularization and reflux. Full and partial strip-tract revascularization and reflux was seen in 12.8% and 59% of limbs of patients, respectively, and 10.2% limbs of patients had neovascularization only at the saphenofemoral junction only. Seven limbs of patients showed no revascularization. Conclusion Five to eight years after high saphenous tie and stripping, 82% of legs of patients showed some strip-tract revascularization and reflux and 12% showed total revascularization and reflux of the stripped great saphenous vein.

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The haemodynamic causes of skin changes in limbs with primary varicose veins

Phlebology The Journal of Venous Disease ◽

10.1177/0268355518774431 ◽

2018 ◽

Vol 34 (2) ◽

pp. 88-97

Author(s):

Yasushi Shiraishi

Keyword(s):

Varicose Vein ◽

Varicose Veins ◽

Normal Group ◽

Inflow Rate ◽

Venous Reflux ◽

Skin Changes ◽

Significant Difference ◽

Arterial Inflow ◽

Primary Varicose Veins ◽

Air Plethysmography

Objectives To investigate the haemodynamic causes of skin changes in limbs with primary varicose veins, which were assessed with air plethysmography. Methods Five hundred seventeen consecutive patients with axial reflux in the great saphenous vein (varicose vein group) and 248 normal subjects (normal group) were investigated. Varicose vein group patients were divided into two groups according to whether they did (C4–6) or did not (C2–3) have skin changes. Several parameters obtained using air plethysmography were compared among the normal group, C2–3 and C4–6 patients. Results Although there was no significant difference in the regurgitation index to quantify venous reflux in C2–3 and C4–6 patients, the maximum arterial inflow rate increased (normal group < C2–3 < C4–6), even in limbs with a small amount of venous reflux. Conclusions This study suggests that it is not essential to increase the venous reflux rate in skin change development; rather, it is based on various pathophysiological conditions that increase the arterial inflow rate.

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A review of a new Dutch guideline for management of recurrent varicose veins

Phlebology The Journal of Venous Disease ◽

10.1177/0268355516631683 ◽

2016 ◽

Vol 31 (1_suppl) ◽

pp. 114-124

Author(s):

James A Lawson ◽

Irwin M Toonder

Keyword(s):

Varicose Vein ◽

Guideline Development ◽

Varicose Veins ◽

Compression Therapy ◽

Venous Ulcer ◽

Venous Disease ◽

Dutch Guideline ◽

Recurrent Varicose Veins ◽

Natural Progression ◽

Initial Intervention

In 2013, the new Dutch guideline for “Venous Pathology” was published. The guideline was a revision and update from the guideline “Diagnostics and Treatment of Varicose Veins” from 2009 and the guideline “Venous Ulcer” from 2005. A guideline for “Deep Venous Pathology” and one for “Compression Therapy” was added to the overall guideline “Venous Pathology.” The chapter about treatment of recurrent varicose veins after initial intervention was recently updated in 2015 and is reviewed here. The Dutch term “recidief varices” or the French “récidive de varices” should be used analogous to the English term “recurrent varicose veins.” The DCOP Guideline Development Group Neovarices concluded that “recidief” in Dutch actually suggests recurrence after apparent successful treatment and ignores the natural progression of venous disease in its own right. So the group opted to use the term “neovarices.” In the Dutch guideline, neovarices is meant to be an all embracing term for recurrent varicose veins caused by technical or tactical failure, evolvement from residual refluxing veins or natural progression of varicose vein disease at different locations of the treated leg after intervention. This report reviews the most important issues in the treatment of varicose vein recurrence, and discusses conclusions and recommendations of the Dutch Neovarices Guideline Committee.

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A comparison of health-related quality of life of patients with primary and recurrent varicose veins

Phlebology The Journal of Venous Disease ◽

10.1258/026835503321236885 ◽

2003 ◽

Vol 18 (1) ◽

pp. 35-37 ◽

Cited By ~ 11

Author(s):

T Beresford ◽

J J Smith ◽

L Brown ◽

R M Greenhalgh ◽

A H Davies

Keyword(s):

Quality Of Life ◽

Varicose Vein ◽

Varicose Veins ◽

Health Related Quality ◽

Recurrent Varicose Veins ◽

Sf 36 ◽

Related Quality ◽

Health Related ◽

Primary Varicose Veins

Aim: To determine whether recurrent varicose veins affect patient quality of life. The health-related quality of life (HRQL) scores of patients with recurrent varicose veins were compared with those of patients presenting with primary varicose vein disease. Methods: HRQL among patients attending outpatient appointments for recurrent and primary varicose veins was measured using the Aberdeen Varicose Vein Questionnaire (AVVQ) and the Short Form-36 General Health Survey (SF-36). Results: Questionnaires were given to 211 patients (150 primary, 61 recurrent), and 194 (133 primary, 61 recurrent) completed them. For the AVVQ, patients with recurrent varicose veins had significantly worse symptom scores compared with those with primary disease (24.87 ± 12.28 vs 17.77 ± 9.68, Mann-Whitney, P <0.01). The SF-36 recorded significantly worse HRQL (Mann-Whitney, P <0.05) for patients with recurrent varicose veins compared with those with primary varicose veins in all but one of the eight domains (role limitation attributed to emotional problems, RE, P = 0.073). Conclusion: Varicose vein recurrence is associated with a significantly worse HRQL than is found among patients with primary varicose veins.

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Patterns of Venous Reflux in 1,027 Lower Limbs with Primary Varicose Veins

Journal for Vascular Ultrasound ◽

10.1177/154431671704100201 ◽

2017 ◽

Vol 41 (2) ◽

pp. 59-65 ◽

Cited By ~ 2

Author(s):

Victoria Carrison ◽

Brooke Tompkins ◽

Lisa Fronek ◽

Nicole Loerzel ◽

Nisha Bunke

Keyword(s):

Saphenous Vein ◽

Varicose Veins ◽

Duplex Ultrasound ◽

Venous Intervention ◽

Lower Limbs ◽

Venous Reflux ◽

Female Ratio ◽

Primary Varicose Veins ◽

Male To Female ◽

Saphenofemoral Junction

Objective The purpose of this study was to investigate the anatomical patterns of superficial venous reflux in patients presenting with primary varicose veins. Methods Ultrasound scans, detailed vein maps, and histories of patients presenting to a single vein center were retrospectively reviewed. Patients included in the study were those presenting with primary varicose veins and classified as clinical, etiologic, anatomic, and pathophysiologic classes 2 through 4. Patients with histories of venous intervention, malformations, active ulcerations, or deep system abnormalities were excluded from this study. Results Overall, 1,027 limbs of 617 patients met the inclusion criterion. The male to female ratio was 1:6.0. Varicose veins were attributed to reflux in the great saphenous vein (GSV) 66% (n = 679) of the time. When GSV reflux was present, the saphenofemoral junction was incompetent 83% of the time. Six percent of varicose veins were attributed to the anterior accessory saphenous vein. Small saphenous vein (SSV) reflux was demonstrated in 34.8% (n = 357). The thigh extension of the SSV and vein of Giacomini demonstrated reflux in 7% (n = 69) and 1% (n = 15) of limbs, respectively. Reflux of nonsaphenous origin was present in 19% (n = 198) of limbs (isolated tributary reflux). Conclusion The variations of superficial venous reflux in patients presenting with primary varicose veins are diverse and complex. Therefore, thorough duplex ultrasound is necessary in all patients with primary varicose veins to evaluate the precise source of reflux to determine therapeutic options.

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Duplex Ultrasound Scanning for Chronic Venous Disease: Recurrent Varicose Veins in the Thigh after Surgery to the Long Saphenous Vein

Phlebology The Journal of Venous Disease ◽

10.1177/026835559601100312 ◽

1996 ◽

Vol 11 (3) ◽

pp. 125-131 ◽

Cited By ~ 8

Author(s):

K. A. Myers ◽

G. H. Zeng ◽

R. W. Ziegenbein ◽

P. G. Matthews

Keyword(s):

Saphenous Vein ◽

Varicose Veins ◽

Duplex Ultrasound ◽

Chronic Venous Disease ◽

Injection Sclerotherapy ◽

Venous Disease ◽

Ultrasound Scanning ◽

Recurrent Varicose Veins ◽

Long Saphenous Vein ◽

Primary Varicose Veins

Objective: To use duplex ultrasound scanning to compare limbs with recurrent and primary varicose veins and to identify connections between deep veins and recurrences. Setting: A non-invasive vascular laboratory in Melbourne, Australia. Patients: A study of 779 limbs with recurrent varicose veins previously treated by ligation or stripping of the long saphenous vein and 1521 limbs with primary varicose veins. Main outcome measures: Connections between deep veins and recurrent varices, reflux in superficial and deep veins, and outward flow in perforators as demonstrated by duplex ultrasonography. Results: Recurrence was due to reflux in the long saphenous territory in 71.8%, short saphenous reflux alone in 14.7% or outward flow in calf perforators without saphenous reflux in 5.2%, while no source was detected in 8.3%. Limbs with recurrent veins in the long saphenous territory were compared with limbs with primary varicose veins; there was more frequent outward flow in thigh perforators (25.2% vs. 16.2%) but no difference for deep reflux (20.7% vs. 17.5%) or outward flow in calf perforators (56.8% vs. 53.1%). The source for recurrence in the long saphenous territory was from a single large connection in the groin in 46.3%, multiple smaller proximal connections in a further 46.3%, or thigh perforators in 7.4%. The destination was to an intact long saphenous vein in 33.7%, major tributaries in 28.7% or to other varices in 37.6%. Limbs known to have been treated by long saphenous ligation alone were compared with those known to be treated by long saphenous ligation and stripping; the source was more likely to be from a single large vein in the groin (60.3% vs. 39.9%) and the destination was more likely to be an intact long saphenous vein or major tributary (75.0% vs. 55.2%). Conclusions: Duplex ultrasound scanning detected the source of recurrent varicose veins in over 90% of patients and demonstrated whether there were single large or multiple smaller connections in the veins affected, and this helps to select the most appropriate treatment. Recurrence after stripping the long saphenous vein was more likely to be due to multiple small connections passing to scattered varices and this may allow more simple treatment by injection sclerotherapy rather than repeat surgery.

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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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