Clinical symptoms and signs and severity of venous disease are not associated with non-thrombotic iliac vein lesions in patients with primary varicose veins

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

British Journal of Surgery ◽

10.1046/j.1365-2168.1998.00546.x ◽

1998 ◽

Vol 85 (2) ◽

pp. 213-216 ◽

Cited By ~ 25

Author(s):

Sakurai ◽

Gupta ◽

Matsushita ◽

Nishikimi ◽

Nimura

Keyword(s):

Clinical Symptoms ◽

Varicose Veins ◽

Venous Reflux ◽

Anatomical Distribution ◽

Primary Varicose Veins

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Is arteriovenous shunting involved in the development of varicosities? A study of the intraluminal pressure and oxygen content in varicose veins

Phlebology The Journal of Venous Disease ◽

10.1258/phleb.2007.007070 ◽

2008 ◽

Vol 23 (3) ◽

pp. 137-141 ◽

Cited By ~ 6

Author(s):

M A Murphy ◽

L Hands

Keyword(s):

Oxygen Content ◽

Supine Position ◽

Varicose Veins ◽

Causative Factor ◽

Intraluminal Pressure ◽

Control Group ◽

Venous Disease ◽

Control Subjects ◽

Pulsatile Pressure ◽

Primary Varicose Veins

Objectives Arteriovenous (AV) shunting has been postulated as the underlying cause of varicose veins. The aim of this study was to analyse pressure and oxygen content in primary varicose veins in order to determine evidence of arterial shunting. Methods Thirty-nine patients with varicose veins underwent cannulation of varicosities. The pressure and the blood oxygen content within varicosities were measured in different positions and during exercise. Similar measurements were made in the long saphenous veins of 10 control subjects without venous disease. Results Mean pressure in varicose veins in the supine position was 12.3 mmHg (Standard deviation [SD] 3.6 mmHg). Control subjects had similar pressures measured in the long saphenous vein. No pulsatile pressure tracings were obtained. Varicosity pressures in the erect position averaged 66 mmHg (SD 9 mmHg). In all cases, the pressure correlated with the distance of the varicosity from the heart. Pressure reduction in varicosities after exercise was significantly less than that in control subjects. Recovery time (RT 90) was also significantly shorter than in the control group. Mean venous pO2 in varicosities was 4.5 kPa (SD 1.0) in the supine position dropping to 3.9 kPa (SD 0.9) on standing; these values were not significantly different to samples from control subjects. Conclusions AV shunting is unlikely to be a causative factor in the development of primary varicose veins.

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Venous Volumetry In The Assessment Of The Post-Thrombotic Limb

10.1055/s-0038-1652475 ◽

1981 ◽

Author(s):

C V Ruckley ◽

H M Crawshaw ◽

J Seaton

Keyword(s):

Chronic Venous Insufficiency ◽

Venous Insufficiency ◽

Varicose Veins ◽

Response To Treatment ◽

Venous Disease ◽

Clinical Relapse ◽

Non Invasive ◽

Coefficients Of Variation ◽

Primary Varicose Veins

The reproducibility of venous volumetry has been evaluated in 20 normal legs (N), 20 legs with primary varicose veins (W) and 30 with stable post-thrombotic chronic venous insufficiency (CVI).The test has shown significant differences between the groups in mean relative expelled volume (EV rel, ccs): N 1.65 ± SD 0.66; W 1.01 ± 0.40; CVI 0.64 ± 0.39 and in half refilling time (T3 secs): N 23.9 ± 11.5; W 11.8 ± 7.4; CVI 3.6 ± 1.8. The percent coefficients of variation in tests repeated at intervals of up to a month were as follows.The reproducibility of the test confirms its value as a non-invasive means of measuring the severity of postthrombotic venous disease and thus as a means of assessing response to treatment. Serial volumetric tests on 25 patients before and for up to 12 months after Linton operations for chronic venous insufficiency show significant early improvements in expelled volume. But in many of these patients the refilling time tends to remain short indicating residual valvular incompetence and the possibility of clinical relapse in the long term.

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Association between right heart diastolic function and clinical presentation of chronic venous disease and primary varicose veins of lower extremities

Phlebology The Journal of Venous Disease ◽

10.1177/0268355520901903 ◽

2020 ◽

Vol 35 (7) ◽

pp. 513-519 ◽

Cited By ~ 1

Author(s):

Yury Rusinovich ◽

Volha Rusinovich

Keyword(s):

Right Ventricular ◽

Diastolic Function ◽

Clinical Presentation ◽

Varicose Veins ◽

Chronic Venous Disease ◽

Venous Disease ◽

Right Heart ◽

Right Ventricular Filling ◽

Primary Varicose Veins ◽

Ventricular Filling

Aim This study examines the association between right heart diastolic function and clinical presentation of chronic venous disease and primary varicose veins of lower extremities. Material and methods We performed retrospective analysis of clinical, peripheral venous Duplex and tricuspid Doppler (early diastolic inflow E-wave, late diastolic inflow A-wave, ratios of E to A waves, early diastolic annular e′-wave, late diastolic annular a′-wave and systolic annular s′- wave) data of 85 patients, 133 legs with primary varicose veins. Results We found following significant (p-value < 0.05) associations between tricuspid Doppler and clinical presentation of chronic venous disease and primary varicose veins: Clinical Etiological Anatomical Pathophysiological clinical class influenced late diastolic inflow velocities (C6 class A-wave +11.2 cm/s or +27% in comparison with C2), late diastolic annular velocities (C6 class a′-wave +3.3 cm/s or +22% in comparison with C2), systolic annular velocities (C6 class s′-wave +3.7 cm/s or +27% in comparison with C2) and E/A ratios (C6 class E/A ratio −0.22 or −21% in comparison with C2). Recurrent varices in comparison with previously untreated are associated with significantly lower late diastolic inflow velocities (A-wave −4.4 cm/s or −9%) and preserved E/A ratios. Age significantly influenced tricuspid Doppler (E-, A-, e′-, a′-waves and E/A ratios) in patients with chronic venous disease. Conclusion Clinical presentation of primary varicose veins and chronic venous disease can be associated with the right heart diastolic function: C6 Clinical Etiological Anatomical Pathophysiological class in comparison with C2 is associated with increased right ventricular filling and impaired ventricular relaxation – right heart diastolic dysfunction; recurrent varices in comparison with previously untreated are associated with reduced right ventricular filling and preserved right heart diastolic function. Older age is the most important risk factor for varicose veins and chronic venous disease possible due to significant changes in right ventricular filling and in right heart diastolic function with age.

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Homeostatic feelings – a novel explanation of vein symptoms derived from an experimental patient study

VASA ◽

10.1024/0301-1526/a000807 ◽

2019 ◽

Vol 48 (6) ◽

pp. 492-501

Author(s):

Werner Blättler ◽

Erika Mendoza ◽

Christine Zollmann ◽

John Bendix ◽

Felix Amsler

Keyword(s):

Rating Scale ◽

Varicose Veins ◽

Stress Test ◽

Numeric Rating Scale ◽

Lower Limbs ◽

Venous Disease ◽

Scale Range ◽

Patient Groups ◽

Primary Varicose Veins ◽

Ceap Classification

Summary. Background: Vein symptoms (VS) entail diffuse leg discomfort and pain coinciding with a perception of weighty or swollen legs. Their traditional classification as a form of venous disease may be inaccurate as they occur in patients with no or any venous disorder. We hypothesized that VS would emerge from a primordially standing associated perturbation in the lower limbs which is not necessarily connected with a venous disorder. Patients and methods: Patients were sorted into groups according to the CEAP classification, VS only (C0s), primary varicose veins (C2p), varicose veins plus oedema (C2p and C3), and venous dermatopathy (C4). Patients completed questionnaires before and one week after they were exposed to a test of stationary standing. Results: Patients (N = 127) in the four groups differed by sex, age and body weight. The VS experienced in the preceding week scored the same in all groups at 3.1 on a numeric rating scale (range 0–10; SD 1.6). During standing, lower leg volume increased and symptoms emerged to the same extent across patient groups and were reduced similarly by compression (volume by 1.7 %, symptoms by 41.7 %). The emergence of symptoms was neither correlated with leg volume increase per se, nor with limiting this increase by compression. Symptoms recorded at baseline correlated with the symptoms provoked by the stress test with bare legs while the symptoms reported at follow-up, when stockings were worn regularly, correlated with the stress test with compression. Conclusions: VS, in terms of neuropsychology, reflect a homeostatic disturbance experienced in the presence and absence of venous disease. Thus, VS are not distinctive for the presence of venous disease insofar as they may reflect dynamic homeostatic feelings resulting from a standing-related disequilibrium in the legs’ internal environment.

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EPIDEMIOLOGY OF PRIMARY VARICOSE VEINS OF LOWER LIMB IN A TERTIARY CARE HOSPITAL.

10.36106/ijsr/0826313 ◽

2021 ◽

pp. 30-32

Author(s):

Praveen Kumar Nookala ◽

Sandeep Mahapatra ◽

Anusha Arumalla ◽

Muneer Ahmad Para ◽

Venu Gopal Mustyala ◽

...

Keyword(s):

Vascular Surgery ◽

Lower Limb ◽

Varicose Veins ◽

Tertiary Care ◽

Clinical Manifestations ◽

Lower Limbs ◽

Venous Disease ◽

Care Hospital ◽

Study Results ◽

Primary Varicose Veins

Introduction: Epidemiological studies plays an important role in providing information on the spectrum and frequency of venous disease distribution in a population. In India, study encompassing the clinical evaluation and surgical management of varicose veins on the conventional lines seems a necessity to improve the quality care with the available resources. We have undertaken an epidemiological study on inuence of age, sex, body mass index, posture on clinical manifestations and complications of varicose veins of lower limbs in patients attending the Department of Vascular Surgery . Materials and Methods: A prospective observational study was conducted in Department of vascular surgery on patients with primary varicose veins of lower limb. Patients with secondary varicose veins, recurrent varicose veins, patients less than 18 years, deep vein thrombosis& peripheral arterial disease were excluded from the study. Results: In the present study 88.89% of ulcer patients had combined saphenofemoral(SFJ) and perforator incompetence, while 11.11% of ulcer patients had combined saphenofemoral, saphenopopliteal (SPJ)and perforator incompetence.14% patients present with combined SFJ, SPJ and perforator incompetence. The patients with higher CEAP classication had combined SFJ and SPJ valvular incompetence. Most commonly, the disease affected the males in the age group of 40-50 years. Conclusion: The present study shows that prolonged standing , obesity ,increasing age are the common risk factors for development of varicose veins.

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Embolization is essential in the treatment of leg varicosities due to pelvic venous insufficiency

Phlebology The Journal of Venous Disease ◽

10.1177/0268355515569129 ◽

2015 ◽

Vol 30 (1_suppl) ◽

pp. 81-85 ◽

Cited By ~ 20

Author(s):

O Hartung

Keyword(s):

Local Anesthesia ◽

Lower Limb ◽

Varicose Veins ◽

Iliac Vein ◽

Additional Treatment ◽

Venous Disease ◽

Secondary Patency ◽

Pelvic Venous Insufficiency ◽

Pelvic Congestion

Purpose Pelvic venous insuffiency (PVI) can be responsible for pelvic congestion syndrome (PCS) and also lower limb varicose veins. Material and methods Charts of all women who had pelvic venography for PVI from September 2013 to August 2014 were reviewed. The procedure was performed under local anesthesia through left femoral approach. In case of reflux without associated obstructive lesions, embolization with coils and polidocanol foam was performed during the same procedure. Results 119 women, with median age 39 years were explored (86 with PCS and 102 with lower limb venous disease). Of these, 78 had an isolated reflux and were embolized and 41 had an obstructive disease (29 iliocaval obstructive lesions (ICOL), 4 nutcracker syndrome (NCS), and 8 with an association of both). Median follow-up was 4 months. Of the 12 NCS, 5 had surgical treatment and 7 had stenting of the left iliac vein without embolization. All patients with ICOL without NCS were treated by stenting in 28 and by a Palma procedure in 1 (failure to recanalize). Primary and secondary patency rates were 97% at 12 months. Embolization led to improvement of PCS in 91% (60% without any pain) and of lower limb varicose veins in 51% by itself. If 82% need an additional treatment of lower limb varicose veins, embolization allowed a switch of strategy from surgery to sclerosis. Conclusion PVI can cause lower limb symptoms. In most cases, it is due to reflux and can be treated under local anesthesia by embolization. This technique is safe and efficient. Obstructive lesions must be recognized and treated.

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Correlation between the hemodynamic gain obtained after operation of primary varicose veins and chronic venous disease classification

Acta Cirurgica Brasileira ◽

10.1590/s0102-86502011000800021 ◽

2011 ◽

Vol 26 (suppl 2) ◽

pp. 115-119 ◽

Cited By ~ 3

Author(s):

Nei Rodrigues Alves Dezotti ◽

Edwaldo Edner Joviliano ◽

Takachi Moriya ◽

Carlos Eli Piccinato

Keyword(s):

Surgical Treatment ◽

Varicose Veins ◽

Disease Classification ◽

Clinical Severity ◽

University Hospital ◽

Chronic Venous Disease ◽

Venous Disease ◽

Severe Group ◽

Primary Varicose Veins ◽

Ceap Classification

CONTEXT: Previous studies have demonstrated improvement of venous hemodynamics after surgical treatment of primary varicose veins of the lower extremities using air plethysmography (APG). PURPOSE: To correlate the venous hemodynamics obtained by APG with the CEAP classification after surgical treatment of primary varicose veins. METHODS: We studied 63 limbs of 39 patients (35 women and 4 men) aged on average 46.3 years, operated upon at the University Hospital, Faculty of Medicine of Ribeirão Preto, University of São Paulo, during the period from January 2001 to December 2004. The 63 limbs were divided into the three following groups according to CEAP classification: group C2 + C3 (38 limbs), group C4 (15 limbs) and group C5 + C6 (10 limbs). The patients were evaluated clinically before and 30 to 40 days after surgery by preoperative duplex ultrasonography and pre- and postoperative APG. RESULTS: There was an apparent hemodynamic improvement after surgical treatment of the varicose veins in the two groups of lower severity, but the improvement was significant in the most severe group based on venous filling index. CONCLUSION : Surgical treatment was beneficial for all three groups, but the greatest hemodynamic gain was observed in the group of highest clinical severity (group C5 + C6).

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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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