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

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.

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

Vascular ◽  
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.

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

2014 ◽  
Vol 30 (8) ◽  
pp. 569-572 ◽  
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.

Recurrence patterns after endovenous laser treatment of saphenous vein reflux

2016 ◽  
Vol 31 (7) ◽  
pp. 496-500 ◽  
Author(s):  
Ronald S Winokur ◽  
Neil M Khilnani ◽  
Robert J Min
Keyword(s):  
Laser Ablation ◽  
Varicose Veins ◽  
Endovenous Laser Ablation ◽  
Recurrent Varicose Veins ◽  
Saphenous Veins ◽  
Recurrence Patterns ◽  
Endovenous Laser Treatment ◽  
Saphenofemoral Junction ◽  
Patterns Of Recurrence

Introduction The patterns of recurrent varicose veins after endovascular ablation of the saphenous veins are not well described. Methods The current study describes the ultrasound defined recurrence patterns seen in 58 patients (79 limbs) who returned for evaluation of recurrent varicose veins from a cohort of 802 patients treated with endovenous laser ablation and subsequent sclerotherapy from March 2000 to March 2007 with clinical follow-up until May 2014. Findings The most common ultrasound defined recurrence patterns leading to the varicose veins were new reflux in the anterior accessory saphenous and small saphenous veins as well as recanalization of the treated saphenous segment. Neovascularization at the saphenofemoral junction and incompetent perforating veins as the source of the recurrent veins were not seen. Conclusions The patterns of recurrence following thermal ablation of saphenous veins are different to those seen after surgery. Specifically, new reflux in other saphenous veins is responsible for most recurrent varicose veins and neovascularity seems to be unusual following endovenous laser ablation.

Does the number of pregnancies affect patterns of great saphenous vein reflux in women with varicose veins?

2010 ◽  
Vol 25 (4) ◽  
pp. 190-195 ◽  
Author(s):  
C A Engelhorn ◽  
M F Cassou ◽  
A L Engelhorn ◽  
S X Salles-Cunha
Keyword(s):  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
Varicose Veins ◽  
Duplex Ultrasonography ◽  
Skin Changes ◽  
Colour Flow ◽  
Primary Varicose Veins ◽  
Saphenofemoral Junction ◽  
Vein Reflux

Objectives Impact of pregnancies on great saphenous vein (GSV) reflux patterns deserves clarification. Which GSV segment is most affected? Is the saphenofemoral junction (SFJ) involved? Methods Colour-flow duplex ultrasonography was performed in 583 women extremities with primary varicose veins (clinical, aetiological, anatomical and pathological elements [CEAP C2]), without oedema, skin changes or ulcer. Women with previous thrombosis or varicose surgery were excluded. GSV reflux sources and drainage points were located at SFJ, thigh, knee and calf. Prevalence of most proximal reflux source was noted as a function of 0, 1, 2, 3 and 4 or more pregnancies. χ2 statistics was employed. Results Prevalence of GSV reflux was not dependent on 0, 1, 2, 3 or ≥4 pregnancies: 75%, 69%, 79%, 70% and 76% for right leg ( P = 0.79) and 78%, 81%, 82%, 79% and 73% for left leg ( P = 0.87), respectively. Prevalence of SFJ reflux and GSV reflux, starting at the thigh, knee or calf, was similar and showed no tendencies to increase with number of pregnancies. Conclusions Number of pregnancies did not influence GSV reflux patterns in women with primary varicose veins.

Influence of Preoperative Duplex Ultrasonography on the Operative Procedure for Primary Varicose Vein Surgery

2001 ◽  
Vol 16 (4) ◽  
pp. 149-153
Author(s):  
T. Rautio ◽  
J. Perälä ◽  
H. Wiik ◽  
K. Haukipuro ◽  
T. Juvonen
Keyword(s):  
Varicose Veins ◽  
Treatment Plan ◽  
Operative Procedure ◽  
Subsequent Treatment ◽  
Duplex Ultrasonography ◽  
Varicose Vein Surgery ◽  
Long Saphenous Vein ◽  
Primary Varicose Veins ◽  
The Impact ◽  
Saphenofemoral Junction

Objective: To evaluate the impact of duplex ultrasonography on the treatment plan of patients with uncomplicated primary varicose veins. Methods: Forty-nine consecutive patients (62 legs) with primary uncomplicated varicose veins were examined clinically and with hand-held Doppler (HHD) and duplex ultrasonography in an outpatient clinic on the same day. The plans for subsequent treatment were recorded separately after the two ultrasound examinations. Results: The accuracy of the HHD examination was 0.71 in the saphenofemoral junction (SFJ) and long saphenous vein (LSV trunk). In fifty-six limbs (90%) duplex scanning did not affect the surgical treatment of the patients. Conclusions: Most operations on primary varicose veins can be performed on the basis of clinical and HHD examinations by an experienced surgeon. Duplex ultrasonography can be used selectively in the patients with suspected saphenopopliteal junction (SPJ) reflux or equivocal HHD findings.

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

2017 ◽  
Vol 41 (2) ◽  
pp. 59-65 ◽  
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.

scholarly journals Response to “Commentary on pelvic venous reflux in males with varicose veins and recurrent varicose veins”

2018 ◽  
Vol 34 (1) ◽  
pp. 70-71
Author(s):  
Mark S Whiteley ◽  
Emma B Dabbs ◽  
Eluned L Davis ◽  
Previn Diwakar
Keyword(s):  
Varicose Veins ◽  
Venous Reflux ◽  
Recurrent Varicose Veins

Correlation of the anatomical distribution of venous reflux with clinical symptoms and venous haemodynamics in primary varicose veins

1998 ◽  
Vol 85 (2) ◽  
pp. 213-216 ◽  
Author(s):  
Sakurai ◽  
Gupta ◽  
Matsushita ◽  
Nishikimi ◽  
Nimura
Keyword(s):  
Clinical Symptoms ◽  
Varicose Veins ◽  
Venous Reflux ◽  
Anatomical Distribution ◽  
Primary Varicose Veins

Re-Exploration of the Saphenofemoral Junction in the Treatment of Recurrent Varicose Veins

1995 ◽  
pp. 491-491
Author(s):  
M. P. Viani ◽  
A. Pinto ◽  
R. V. Poggi
Keyword(s):  
Varicose Veins ◽  
Recurrent Varicose Veins ◽  
Saphenofemoral Junction

The Elastic Properties of the Human Great Saphenous Vein in Relation to Primary Varicose Veins

1974 ◽  
Vol 52 (2) ◽  
pp. 153-157 ◽  
Author(s):  
J. Kenneth Booking ◽  
Margot R. Roach
Keyword(s):  
Elastic Properties ◽  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
Varicose Veins ◽  
Simultaneous Measurements ◽  
Saphenous Veins ◽  
Before And After ◽  
Laplace’S Law ◽  
Primary Varicose Veins ◽  
Laplace's Law

Simultaneous measurements of pressure and volume were made on nine great saphenous veins obtained at autopsies and nine great saphenous veins that were stripped during surgery from patients with primary varicose veins. Similar measurements were also made on six great saphenous veins obtained at autopsy before and after they were held at 100 cm H2O for 4 h. Circumferential tensions were calculated from Laplace's law (tension = pressure × radius).The great saphenous veins from patients with primary varicose veins had significantly greater radii and were more distensible than the normal great saphenous veins. After being held at 100 cm H2O for 4 h, the normal great saphenous veins became less distensible and their radii at distending pressures increased.Due to the great difference in radii, the circumferential tension on a great saphenous vein from a patient with primary varicose veins is much greater than that on a normal great saphenous vein at the same distending pressure. However, the physical stresses exerted on the great saphenous veins during the stripping operations may influence our results in some unknown way.

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