Varicose vein appearance caused by perforating vein incompetence detected after intense cycling

The role of incompetent perforating veins in the aetiology of varicose veins is not well understood. Anecdotally, competitive cyclists appeared to be more prone to varicose veins than the general population. We present a case of a 63-year-old amateur competitive cyclist who acutely developed a painful varicosity of her left calf while straining during a hill climb in 106-mile cycle race. Duplex ultrasonography has shown an underlying incompetent perforating vein, feeding the varicosity directly through the underlying muscle. With no other significant venous reflux in either leg, we believe this case shows a clear causative association between the stresses put across the lower leg during competitive cycling and developing a varicose vein via an incompetent perforating vein. We believe this should lead to further investigations as to any link between cycling, perforator vein incompetence and the development of varicose veins.

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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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Results after Re-Operation in the Groin for Recurrent Varices of the Long Saphenous Vein

Phlebology The Journal of Venous Disease ◽

10.1177/026835550201600303 ◽

2002 ◽

Vol 16 (3) ◽

pp. 98-100 ◽

Cited By ~ 1

Author(s):

N. Jessen ◽

N. Bækgaard

Keyword(s):

Recurrence Rate ◽

Saphenous Vein ◽

Varicose Veins ◽

Standard Procedure ◽

University Hospital ◽

Groin Dissection ◽

Perforating Veins ◽

Long Saphenous Vein ◽

Perforating Vein

Objective: To evaluate the outcome of re-operation in the groin for recurrent varicose veins. Design: Retropective follow-up study Setting: Department of Vascular Surgery, Gentofte University Hospital, Copenhagen, Denmark. Methods and materials: Thirty-two patients with 43 operated legs. Operations were performed between January 1996 and the end of April 1997 and solely as a groin dissection; no stripping was done. Follow-up consisted of a clinical examination and duplex scanning with an ATL HDI 5000 scanner. Results: Sixteen cured legs, 17 with reflux beginning at mid-thigh, mainly a Hunter's perforating vein, and 10 with remaining reflux at the sapheno-femoral junction. Conclusion: Recurrence rate in the groin is acceptable. Stripping of the long saphenous vein is mandatory to bring down the recurrence rate from mid-thigh perforating veins. This is now standard procedure in our department.

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Factors Associated with Recurrence of Varicose Veins after Thermal Ablation: Results of The Recurrent Veins after Thermal Ablation Study

The Scientific World JOURNAL ◽

10.1155/2014/505843 ◽

2014 ◽

Vol 2014 ◽

pp. 1-7 ◽

Cited By ~ 32

Author(s):

R. G. Bush ◽

P. Bush ◽

J. Flanagan ◽

R. Fritz ◽

T. Gueldner ◽

...

Keyword(s):

Saphenous Vein ◽

Varicose Vein ◽

Thermal Ablation ◽

Great Saphenous Vein ◽

Varicose Veins ◽

Time Frame ◽

Factors Associated ◽

Perforating Veins ◽

Contributory Factors ◽

Ablation Study

Background. The goal of this retrospective cohort study (REVATA) was to determine the site, source, and contributory factors of varicose vein recurrence after radiofrequency (RF) and laser ablation.Methods. Seven centers enrolled patients into the study over a 1-year period. All patients underwent previous thermal ablation of the great saphenous vein (GSV), small saphenous vein (SSV), or anterior accessory great saphenous vein (AAGSV). From a specific designed study tool, the etiology of recurrence was identified.Results. 2,380 patients were evaluated during this time frame. A total of 164 patients had varicose vein recurrence at a median of 3 years. GSV ablation was the initial treatment in 159 patients (RF: 33, laser: 126, 52 of these patients had either SSV or AAGSV ablation concurrently). Total or partial GSV recanalization occurred in 47 patients. New AAGSV reflux occurred in 40 patients, and new SSV reflux occurred in 24 patients. Perforator pathology was present in 64% of patients.Conclusion. Recurrence of varicose veins occurred at a median of 3 years after procedure. The four most important factors associated with recurrent veins included perforating veins, recanalized GSV, new AAGSV reflux, and new SSV reflux in decreasing frequency. Patients who underwent RF treatment had a statistically higher rate of recanalization than those treated with laser.

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The role of transillumination phleboscopy in the planning of cosmetic operations for varicose veins

Jornal Vascular Brasileiro ◽

10.1590/s1677-54492009000400006 ◽

2009 ◽

Vol 8 (4) ◽

pp. 313-317

Author(s):

Ricardo C. Rocha Moreira ◽

Márcio Miyamotto ◽

Ramzi Abdallah El-Hosni Jr. ◽

Barbara D’Agnoluzzo Moreira

Keyword(s):

Varicose Vein ◽

Lower Limb ◽

Varicose Veins ◽

Careful Planning ◽

Operations Planning ◽

Cosmetic Results ◽

Essential Step ◽

Main Activity ◽

Reticular Veins

Background: The cosmetic treatment of varicose veins is the main activity of most vascular surgeons in Brazil. In order to obtain satisfactory cosmetic results, careful planning of varicose vein operations is necessary. Objective: Marking (or "mapping") the varicose veins with indelible ink is an essential step in planning cosmetic surgeries for lower limb varicose veins. In the present study, the role of transcutaneous phleboscopy (TcPh) in planning varicose vein operations is evaluated. Methods: A series of 100 consecutive patients, all female, were evaluated with TcPH as part of their varicose vein operations planning. A total of 171 limbs with varicose veins (71 bilateral and 29 unilateral) were evaluated. The process of marking the varicose veins followed the same protocol in all cases. Firstly, the varicose veins were marked by inspection and palpation, with the patient standing, using an indelible black ink pen. Secondly, with the patients resting in supine and prone positions, the varicose veins detected with TcPh were marked again with red or blue ink. The marks made by the two methods were then compared. Results: In 41 patients, for a total of 80 limbs (46.8%), the marks were altered after use of TcPh. Reasons for such changes were: 1) identification of other varicose veins; 2) identification of reticular veins draining complex telangiectasias; and 3) changes in the position of the marks placed with the patient standing. Conclusions: TcPh has altered the planning of varicose vein surgeries in 46.8% of all limbs evaluated, especially when the patients had complex telangiectasias, associated with reticular varicose veins.

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Which Way Does Blood Flow in the Perforating Veins of the Leg?

Phlebology The Journal of Venous Disease ◽

10.1177/026835559100600211 ◽

1991 ◽

Vol 6 (2) ◽

pp. 127-132 ◽

Cited By ~ 12

Author(s):

G. M. McMullin ◽

P. D. Coleridge Smith ◽

J. H. Scurr

Keyword(s):

Blood Flow ◽

Ultrasound Imaging ◽

Clinical Evidence ◽

Duplex Ultrasound ◽

Venous Disease ◽

Distal Limb ◽

Perforating Veins ◽

Perforating Vein ◽

Precise Role

There is controversy about the precise role of calf perforating veins in venous disease. Previous studies have shown that the direction of flow is principally inward and that outward flow may be used as a means of diagnosing perforator ‘incompetence’. Fifty-six perforating veins in 25 patients with clinical evidence of venous disease were examined using duplex ultrasound imaging. Only one perforating vein showed outward flow on distal compression of the limb, whereas local compression elicited outward flow in 38. Distal limb compression cannot be used to assess the ‘competence’ of calf perforating veins.

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Subfascial endoscopic perforator surgery using a soft trocar for varicose veins in the lower leg

Phlebology The Journal of Venous Disease ◽

10.1258/026835503321236876 ◽

2003 ◽

Vol 18 (1) ◽

pp. 30-34

Author(s):

Masayuki Hirokawa ◽

Yoshinori Inoue ◽

Takehisa Iwai

Keyword(s):

Carbon Dioxide ◽

Polyvinyl Chloride ◽

Varicose Veins ◽

Lower Leg ◽

Wound Complications ◽

Perforating Veins ◽

Carbon Dioxide Gas ◽

Sealing Ring ◽

Primary Varicose Veins ◽

Subfascial Endoscopic Perforator Surgery

Objective: To describe the use of a novel soft trocar to perform subfascial endoscopic perforator surgery (SEPS) in patients with varicose veins in the lower leg. Procedures: From January 1999 through March 2001, SEPS was performed in 14 patients (17 legs) with primary varicose veins (clinical classes 3-6) by using a soft trocar. The soft trocar is a Y-shaped polyvinyl chloride bag with two ports at one end and a flexible, sealing ring at the opposite end. The subfascial space was dissected with an endoscopic dissection cannula and expanded with a balloon. Carbon dioxide gas insufflation was applied, and the perforating veins were divided by using UltraShears inserted simultaneously with an endoscope through the second port of the trocar. Results: A mean of 4.7 ± 2.9 perforating veins per leg were divided. No wound complications occurred. Conclusion: Use of the soft trocar facilitates both visualization and manipulation during SEPS.

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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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Suprapubic varicose vein formation during pregnancy following pre-pregnancy pelvic vein embolisation with coils, without any residual pelvic venous reflux or obstruction

SAGE Open Medical Case Reports ◽

10.1177/2050313x17724712 ◽

2017 ◽

Vol 5 ◽

pp. 2050313X1772471 ◽

Cited By ~ 2

Author(s):

Emma Dabbs ◽

Jaya L Nemchand ◽

Mark S Whiteley

Keyword(s):

Varicose Vein ◽

Varicose Veins ◽

Iliac Vein ◽

Subsequent Pregnancy ◽

Common Iliac Vein ◽

Venous Reflux ◽

Foam Sclerotherapy ◽

Pelvic Vein ◽

Vein Formation ◽

Collateral Vein

Suprapubic varicose veins are usually indicative of unilateral iliac vein occlusion and venous collateralisation. We report two cases of suprapubic varicose veins following pelvic vein embolisation and subsequent pregnancy; both presented without residual pelvic venous reflux or pelvic venous obstruction. In both cases, there was no significant flow in the suprapubic veins indicating that they were not acting as a collateral post-pregnancy. One patient had this venous abnormality treated successfully with TRansluminal Occlusion of Perforators, followed by foam sclerotherapy to the main part of the suprapubic vein. This patient has since completed the reminder of her lower limb varicose vein treatment. We suggest that pregnancy may have caused prolonged intermittent compression of the left common iliac vein, and that this, together with the physiological impact of previous embolisation procedures, obstructed venous drainage from the left leg resulting in collateral vein formation within the 9-month gestation period.

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Surgical treatment of varicose vein using the tumescent technique of local anesthesia

Vojnosanitetski pregled ◽

10.2298/vsp1102155b ◽

2011 ◽

Vol 68 (2) ◽

pp. 155-160 ◽

Cited By ~ 1

Author(s):

Zoran Bjelanovic ◽

Ivan Lekovic ◽

Miroljub Draskovic ◽

Sidor Misovic ◽

Milic Veljovic

Keyword(s):

Surgical Treatment ◽

Local Anesthesia ◽

Varicose Vein ◽

Varicose Veins ◽

Subcutaneous Tissue ◽

Good Alternative ◽

Systemic Complications ◽

Perforating Veins ◽

Alternative Method ◽

Surgery Of Varicose Veins

Background/Aim. Tumescent local anesthesia (TLA) is a technique for local and regional anesthesia of the skin and the subcutaneous tissue, using infiltration of large amounts of a diluted solution of local anesthetic. This technique is applied in plastic surgery, liposuction as well as in dermatology for the entire series of dermatocosmetic procedures. The purpose of this study was to determine efficiency of surgical treatment of varicose vein using TLA as an alternative method to a conventional treatment for varicose vein. Methods. Seventy-two patients with varicose vein were enrolled in the study. All of them were operated on applying TLA, from April 2008 to November 2009. TLA solution consisted of local anesthetics was used. TLA solutions used were: 1% prilocaine-chloride with adrenaline supplement, and 2% lidocaine-chloride and adrenaline in concentration of 0.1%-0.4%. Results. Out of 72 patients, we stripped great saphenous vein from 60 patient and did varicectomy as well as ligation of insufficiently perforating veins. In 12 patients we did partial varicectomy and ligation of perforating veins. There were not any patients with the need for continued surgery, as well as bringing patient to the general anesthesia due to pain during the surgery. One patient came for postoperative opening wound in the groin, one for infection of the wound and one for the formation of seroma in the groin. There were not any allergic reactions or systemic complications in the operations as well as postoperative period. Postoperatively, all the patients were treated with compressive elastic bandage during the period of 6 weeks as well as anticoagulation prophylaxis in the duration of 5 days. Conclusion. Surgery of varicose veins with implementation of TLA is easy and safe method with very low percentage of complications and unwanted effects. It is a good alternative method to classic surgery of varicose veins. The economic aspect is a very important component because the cost of this method is significantly lower than that of a classical surgical treatment of varicose veins.

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