Development Of Chronic Venous Insufficiency Research Articles

Factors Influencing Venous Remodeling in the Development of Varicose Veins of the Lower Limbs.

One of the early symptoms of chronic venous disease (CVD) is varicose veins (VV) of the lower limbs. There are many etiological environmental factors influencing the development of chronic venous insufficiency (CVI), although genetic factors and family history of the disease play a key role. All these factors induce changes in the hemodynamic in the venous system of the lower limbs leading to blood stasis, hypoxia, inflammation, oxidative stress, proteolytic activity of matrix metalloproteinases (MMPs), changes in microcirculation and, consequently, the remodeling of the venous wall. The aim of this review is to present current knowledge on CVD, including the pathophysiology and mechanisms related to vein wall remodeling. Particular emphasis has been placed on describing the role of inflammation and oxidative stress and the involvement of extracellular hemoglobin as pathogenetic factors of VV. Additionally, active substances used in the treatment of VV were discussed.

The Role of the Vegfa C936t Polymorphism in the Development of Chronic Venous Insufficiency of the Legs And Its Analysis

In 98 patients, an analysis of the genetic risk factor for the development of chronic venous insufficiency was carried out by studying the frequency of distribution of alleles and genotypes of the C936T polymorphism in the VEGFA gene. In both groups, the actual distribution of C807T polymorphism genotypes corresponded to those expected under the Hardy-Weinberg equilibrium (p
 <0.05). A significant relationship was established between the risk of developing chronic venous insufficiency and the distribution of predisposing/protective variants of the C807T polymorphism genotypes in the VEGFA gene. These data allow us to suggest testing this locus to predict the risk of occurrence and progression of chronic venous insufficiency>

Evolution of deep vein thrombosis treatment from leeches to mechanical thrombectomy.

Deep vein thrombosis (DVT) is one of the most common diseases in developed countries with significant socioeconomic consequences. The severity of DVT lies in the potential for life-threatening pulmonary embolism and the development of chronic venous insufficiency, referred to as post-thrombotic syndrome. Virchow contributed to the understanding of the pathophysiological events that lead to thrombosis by describing three basic risk mechanisms. The first therapeutic attempts in the 17th century included venepuncture and the application of leeches. The first anticoagulant drug was heparin, which entered clinical practice after 1935. Subsequent commercialization of oral vitamin K antagonists (warfarin) and the advent of low molecular weight heparin along with compression therapy allowed the expansion of outpatient treatment of DVT. Recently, new oral anticoagulants have been introduced, leading to improved safety due to lower risk of bleeding complications and simplification of the treatment process. The next step in the development of therapeutic options are invasive methods of early thrombus removal, which significantly shorten the process and aim to reduce the occurrence of late complications. These methods include local catheter-directed thrombolysis using tissue plasminogen activator, mechanical thrombectomy and their combination called pharmaco-mechanical thrombectomy. The latter is currently used in patients with acute ilio-femoral DVT.

The relationship between venous insufficiency and serum magnesium level

Magnesium is the second most common cation in the cell. In addition to its role as a cofactor in many enzymatic pathways in physiological processes, it is necessary for the regular functioning of vascular smooth muscle cells. Magnesium deficiency has been associated with exacerbation of inflammation, which plays a role in the aetiopathogenesis of many diseases. To investigate the potential relationship between serum magnesium level and the development of chronic venous insufficiency by comparison with healthy individuals. The study included 394 patients with venous insufficiency based on physical examination findings and colour Doppler ultrasonography, and 206 controls without venous insufficiency. Venous insufficiency was defined by colour Doppler as reflux lasting 0.5 seconds or more in superficial veins, and longer than one second in femoral and popliteal veins. Clinical, haematological and biochemical parameters, including serum magnesium level and indicators of inflammation, were compared between groups. A total of 600 participants were included. There was no significant difference between the groups in terms of age and gender. In total, 187 (47.46%) patients with chronic venous insufficiency and 105 (50.97%) of the control group were male (p=0.414). The median age of the patients with chronic venous insufficiency was 48 (min-max: 41-49), and the median age of the control group was 49.00 (min-max: 45.00-60.25) (p=0.064). Serum magnesium level was found to be significantly lower in the group with chronic venous insufficiency compared to the control group; 1.90 mg/dL (min-max: 1.82-2) versus 2.1 mg/dL (min-max: 2-2.2) (p<0.001), respectively. Low serum magnesium levels may pose a potential risk for the development of chronic venous insufficiency, which is common in the community.

Th17-Gene Expression Profile in Patients with Chronic Venous Disease and Venous Ulcers: Genetic Modulations and Preliminary Clinical Evidence.

Chronic venous disease is a condition globally widespread, resulting in a disabling pathological disorder. The CD4 + Th17+ (Cluster Differentiation 4) lymphocytes represent a regulative factor for innate immunity related to the development of complex diseases. Recently, these mechanisms have been associated with vascular disease. The aim of this work is to validate whether the Th17 response correlates with the development of CVI (Chronic venous insufficiency)and CVLUs (chronic venous limbs ulcers) and whether Th17 markers can be used, both as intrinsic risk factors and diagnostic markers, for disease development. PBL derived from peripheral blood samples of patients and controls were subjected to gene expression analysis for IL23R, IL17, SGK1, TGFβ, RORγ, FOXO1, and RANBP1 by qRT-PCR and immunoblot. A post hoc correlation, the diagnostic performance of the target genes, and multivariable analyses were properly conducted. The main expression markers of the CD4 + Th17+ switch were strongly activated in chronic venous insufficiency and in advanced ulceration. The correlation analysis demonstrated the inter-dependence on Th17’s signature modulation. ROC (Receiver Operating Characteristic) analysis defined, for the examined genes, a clinical value as the potential diagnostic markers. Multi-logistic regression studies showed that Th17 markers behave as empirical risk factors for CVD (chronic venous disease) development. Taken together, the present data provide a new hypothesis for the TH17-dependent pathogenesis of CVD, favoring the possibility for the development of new diagnostic, preventive, and therapeutic approaches.

ЭПИДЕМИОЛОГИЯ ГОСПИТАЛИЗИРОВАННОЙ ЗАБОЛЕВАЕМОСТИ ВАРИКОЗНОЙ БОЛЕЗНЬЮ В МЕГАПОЛИСЕ

Chronic venous insufficiency of the lower extremities is currently one of the most common pathologies of the human vascular system and represents an important socio-economic problem for developed countries both due to its high prevalence and due to the cost of diagnosis and treatment. In the medical literature, the analysis of treated patients in a hospital is limited only to a certain contingent of patients in a given hospital or to the study of specific degrees of chronic venous insufficiency. We did not find data on the hospitalized morbidity of varicose veins, which would indicate its structure, in the literature available to us. We studied 10326 statistical maps and case histories of patients with varicose veins with venous insufficiency C2-C6 according to CEAP classification, treated from 2010 to 2019 in the city vascular center operating on the basis of the city clinical hospital of Minsk, all patients underwent various surgical procedures. interference. The structure of hospitalized morbidity, its growth over the years, the influence of the age of men and women on the development of chronic venous insufficiency are shown. The main reasons for the development of chronic venous insufficiency have been analyzed.

Modern views on the development of varicose and post-thrombotic diseases

Chronic diseases of the veins of the lower extremities include vascular pathologies within the venous system and exclude those, in which the veins suffer secondarily (chronic heart failure, iatrogenic damage, tumour occlusion). The main clinical and morphological forms of chronic diseases of the veins of the lower extremities include: varicose veins, post-thrombotic disease and phlebodysplasia. Moreover, according to publications, varicose disease accounts for the main percentage of occurrence, i.e. from about 70 to 86 %. Post-thrombotic disease occurs from 14 to 29 % of cases and develops, as a rule, during the first two years after an episode of deep vein thrombosis of the lower extremities in 20–50 % of patients. These two diseases are the main reason for the development of chronic venous insufficiency with a significant decrease in working capacity and quality of life under the age of 60. Despite the achievements of modern science, the ethiopathogenesis of these diseases is yet to be understood. Instrumental diagnostics allows a pathological retrograde blood fl ow due to the failure of the valves of the venous system of the lower extremities to be determined. However, the issue of what is primary — valvular insufficiency or venous wall deformation — remains open at the present time. This article is devoted to a review of modern theories about the mechanisms underpinning the formation of valvular insufficiency in varicose and post-thrombotic diseases. The review also addresses systemic hemodynamic disorders (heart morphology and hemodynamics) against the background of chronic diseases of the veins of lower extremities.

High prevalence of chronic venous disease among health care workers in the United States

BackgroundHealth care workers spend extended times standing and walking short distances and are at risk for development of chronic venous insufficiency (CVI). We conducted a hospital-wide venous screening program designed to measure the prevalence of and risk factors for clinical manifestations of CVI and ultrasound evidence of venous reflux or obstruction in health care workers. We also determined their risk for deep venous thrombosis (DVT). MethodsFree venous screening and education were offered to all hospital employees; the program started in April 2016, and results are presented from the first year. Demographics, medical history, and use of compression stockings were recorded. A physical examination determined the clinical class of the Clinical, Etiology, Anatomy, and Pathophysiology (CEAP) classification for clinical disease, and an ultrasound test evaluated for reflux or obstruction in the common femoral vein, popliteal vein, and saphenofemoral junction. The Caprini score was recorded to evaluate risk of DVT. Descriptive statistics were reported, and logistic regression was used for multivariate analysis of risk factors. ResultsWe enrolled 636 participants (1272 legs); 93.0% were women. The median age was 42 years (interquartile range, 31-52 years), mean body mass index was 29.2 ± 6.6 kg/m2, and most participants were white (49.1%) or African American (39.5%); 18% reported having hypertension, 7.1% had diabetes, and 6.1% were current smokers. The majority reported occasional leg pain (72.7%) and evening leg swelling (42.3%). Only 2.7% used daily compression stockings. Clinical evidence of CVI was present in at least one leg in 69.1% (C1, 49.0%; C2, 17.7%; C3, 1.9%; C4, 0.2%; C5, 0.2%). Venous reflux was present in at least one leg in 82.1%; obstruction was rare (0.2%). Reflux in either the superficial (saphenofemoral junction) or the deep (femoral or popliteal) venous system was present in the majority (71.0%) of patients with CVI (clinical class ≥C1). Reflux and white race were risk factors for clinical disease; clinical disease, age, female sex, and white race were risk factors for reflux. On the basis of the Caprini score, 14.1% of participants were in the highest risk category for DVT when experiencing a high-risk situation (including 2.2% with history of DVT). ConclusionsPrevalence of clinical CVI and venous reflux is high among health care workers despite a low frequency of cardiovascular comorbidities. Increased awareness about CVI and DVT and preventive strategies for venous disease must be instituted in this high-risk cohort.

Endovascular correction of venogenic erectile dysfunction in May–Thurner syndrome (clinical case)

Introduction. Secondary varicose small pelvic veins with the development of chronic venous insufficiency due to obstruction of the magistral venous vessels, in particular, the left common iliac vein and the right common iliac artery (May–Thurner syndrome), occupy a special place in the structure of the causes of venogenic erectile dysfunction (ED).The study objective is to present the clinical case of arteriovenous conflict (May–Thurner syndrome), leading to the development of secondary varicose small pelvic veins in men and venogenic ED, as well as modern methods of its verification and endovascular surgical repair.Clinical case. A clinical case of successful endovascular correction of venogenic ED is presented. The patient is diagnosed with: May– Thurner syndrome. Pelvic varicose disease С3 (according to CEAP Classification). Condition after endovascular balloon angioplasty and stenting of the left common iliac vein. Bilateral varicocele. Condition after bilateral varicocelectomy in 2018. Severe venogenic ED (pathological venous drainage, proximal type, International Index of Erectile Function (v. 5) – 12 points; Er3 according to the Unem Scale) in accordance with the Comprehensive Classification System for Chronic Venous Disorders. On July 24, 2019 endovascular occlusion of the Santorini’s plexus veins was performed with the installation of occlusion spirals in their lumen according to Gianturco. In order to provide visualization of the veins in the Santorini’s plexus, given the impossibility of cannulation of the deep vein of the penis, bilateral symmetrical cannulation of the cavernous bodies of the penis was carried out to perform cavernosophlebography. The left common iliac vein was catheterized according to the Crossover technique. Under phlebography control we ensured that the stent in the common iliac vein passed without signs of loss of its lumen. The internal pudental vein on the left was selectively catheterized. Hydrophilic guidewire was introduced through the veins of the periprostatic plexus into the right internal pudental vein. Selective catheterization of the periprostatic venous plexus was not possible due to pronounced tortuosity, valve flaps of the veins and small diameter of the catheterized veins. It was decided to pass the guidewire further through the right iliac vein system with access to the inferior vena cava. Further, the guidewire was again transferred to the left common iliac vein (double crossover). The left common femoral vein was punctured followed by the placement of 5 Fr introducer sheath according to Seldinger. The guidewire tip was fixed by the loop in the left common iliac vein, then captured and brought out through the introducer in the left common femoral vein. A catheter Сobra15 Fr was inserted through a crossover guide from the left common femoral vein into the right internal iliac vein and further into the periostatic venous plexus. Gradually veins of the Santorini’s plexus were selectively catheterized followed by Gianturco coils embolization.Conclusion. The first choice surgery for verified proximal type ED is endovascular occlusion of the veins in the Santorini’s plexus through the deep vein of the penis, which allows to change the hemodynamics in the penis and provide sufficient erection without resorting to endofalloprosthesis of the penis. Single or double-sided transfemoral access is suggested for patients when access through the deep vein of the penis is rather challenging or absent.

Protocol for a systematic review and meta-analysis of interventions for pathologic perforator veins in chronic venous disease

IntroductionPerforator veins (PVs) play an important role in the development of chronic venous insufficiency and ulceration. Procedures to eliminate incompetence and reflux in PV may include open surgery, subfascial endoscopic...

УЛЬТРАЗВУКОВАЯ ДОППЛЕРОГРАФИЯ ХРОНИЧЕСКОЙ ВЕНОЗНОЙ НЕДОСТАТОЧНОСТИ НИЖНИХ КОНЕЧНОСТЕЙ

Мета дослідження - вивчити можливості ультразвукової доплерографії в діагностиці хронічної венозної недостатності (ХВН) нижніх кінцівок.Матеріали та методи. Проведено обстеження 176 пацієнтів з ХВН. Використаний метод колірної доплерографії.Результати та обговорення. ХВН у обстежених пацієнтів виявлявся різноманітної клінічної симптоматикою. Для оцінки тонусу венозної стінки визначали індекс еластичності (ІЕ) загальної стегнової і підколінної вен, для визначення «нормальності» анатомічної будови великої підшкірної вени на стегні визначали індекс гіпоплазіі.Характерізова гемодинамичну значимість, розділили всіх обстежених хворих за ступенями тяжкості на три групи. У першій групі при проведенні проб на клапанах в сафенофеморальному сполученні ретроградний кровотік не фіксували, що підтверджувало відсутність клапанної недостатності. Значення ІЕ не перевищував 1,37 ± 0,09. У другій групі реєстрували ретроградний потік крові тривалістю не більше 2 секунд, що свідчить про гемодинамично незначну недостатність. Значення ІЕ був вище 1,37. У пацієнтів третьої групи при проведенні проб на клапанах в сафенофеморальне сполучення реєструвався ретроградний потік крові, що дозволило виявити гемодинамічно значиму клапанну недостатність, при якому показана хірургічна корекція. Середні показники ІЕ глибоких вен перевищували нормальне значення і становили для загальної стегнової вени 1,7 ± 0,042, для підколінної вени -1,6 ± 0,028.Висновки. Ультразвукова доплерографія дозволила виявити клапанну недостатність різних відділів венозного русла нижніх кінцівок і зробити висновок про ступінь порушення венозного відтоку вен нижніх кінцівок. Вивчення за допомогою ультразвукової доплерографії тоніко-еластичних властивостей венозної стінки є одним з важливих моментів в діагностиці стану венозної системи нижніх кінцівок і має важливе практичне значення. Розвиток ХВН - процес, протяжний в часі, тобто за умови виявлення і лікування захворювання на ранніх стадіях можна реально скоротити кількість хворих або пролонгувати в часі розвиток важких форм хвороби.

Approach to venous diseases in the elderly

Incidence and severity of both deep vein thrombosis and chronic venous insufficiency are increased with age. Today, however, the significance of these diseases in the elderly patient population are still poorly comprehended. Although most patients have a history of previous treatment, chronic venous insufficiency is usually encountered in the advanced clinical stage. As a result, there is an increase in mobility restrictions, the need for assistance in daily activities and the risk of falls in elderly patients. The quality of life is negatively affected in patients. Age, immobilization and obesity are the main risk factors for the development of chronic venous insufficiency in the elderly. Patients present with complaints such as pain, edema, burning, bloating, weight sensation, restless leg syndrome, night cramps, varicosities, color change and open wound in the legs. In diagnostic procedures, color Doppler ultrasonography examination is used together with patient's staging as well as history and physical examination. Classification of "Clinical-Etiology- Anatomy-Pathology (CEAP)" is used in defining venous insufficiency patients. Among the leading differential diagnoses are congestive heart failure, renal failure, liver dysfunction, antihypertensive, non-steroidal anti-inflammatory and some antidiabetic medications and lymphedema and deep vein thrombosis. Patients underwent early diagnosis and long-term regular follow-up after appropriate therapeutic interventions reduce the risk of developing advanced complicated clinical conditions. The main components of treatment include patient education, mobilization, leg elevation, prevention of obesity, use of venous compression stockings, use of venoactive agents, and catheterbased/ surgical interventions. Endovenous radiofrequency or laser ablation techniques and endovenous chemical ablation techniques in superficial venous insufficiency are preferential interventional modalities due to low morbidity risks in older age group of chronic superficial venous insufficiency patients. Foam sclerotherapy for superficial truncal varicosities can also be considered as an alternative for older age groups. In any treatment decision to be taken, the risk-benefit ratio, the patient's clinical status, the available treatment options as well as the patientspecific risks and the patient's expectation and decision should be the main determinant. It is important to remember that what is more important than the age of the patient is the patient's own physical condition and that the quality of life is improved.

Elastic stockings effect on leg volume variability in healthy workers under prolonged gravitational gradient exposure

The aim of this study was to determine the elastic stockings effect on healthy workers (HW) who are exposed to a prolonged hydrostatic pressure overload for professional reasons. The cohort was composed by 20 HW who voluntarily underwent a water plethysmography test before and after eight hour of standing up in an operating room, wearing elastic stockings. After 8 h of gravity exposure, we demonstrated the absence of leg volume increase in case of elastic stockings use. In the morning measurement we found that the lower limb volume was 1967.5 mL±224, while in the evening it was 1962.5 mL±227 (P&amp;lt;0.0828). The decreased volume is significantly correlated with the time that was spent under gravity forces for working purpose wearing elastic stockings (R&lt;sup&gt;2&lt;/sup&gt;=0.99, P&amp;lt;0.0001). Our experiment demonstrates that elastic stockings may effectively counteract the increased leg volume over time in workers who are exposed to prolonged gravitational gradient. Further longitudinal studies are needed to determine if the above effect could correct one of the major risk factors for the development of chronic venous insufficiency.

Current state of the treatment of perforating veins.

Perforating veins may play a role in the development of chronic venous insufficiency and ulceration. There is renewed interest in minimally invasive treatments vs historic surgical options. Current indications for treatment, technical success, and evidence for clinical efficacy are summarized. Existing recommendations include perforator closure in Clinical, Etiology, Anatomy, and Pathophysiology class 5 or class 6 disease through percutaneous thermal ablation, subfascial endoscopic perforator surgery, open surgery, or sclerotherapy. Closure rates for percutaneous thermal ablation are reported as 60% to 80% initially. More recanalization and de novo perforator formation have been reported than after thermal saphenous closure. Ultrasound-guided foam sclerotherapy has shown promise in perforator closure and wound healing, but with variable success rates. Regardless of method used, successful closure of perforators appears predictive of wound healing with minimal morbidity. However, the power and design of all studies supporting this are far from robust, and more work is needed.

Incidence of chronic venous disease in the Edinburgh Vein Study.

Epidemiologic research in chronic venous disease has focused on prevalence and associated risk factors. Evidence on the risks and incidence that this condition will develop is limited. The aim of this study was to measure the incidence of new varicose veins and chronic venous insufficiency (CVI) in an adult population and to investigate risk factors associated with the development of these conditions. The Edinburgh Vein Study is a cohort study of a random sample of the general population. Invitations were sent to 1456 men and women at baseline to participate in a 13-year follow-up examination. Each participant completed a questionnaire on lifestyle and medical history and underwent an examination that included clinical classification of venous disease. After a mean follow-up of 13.4 (standard deviation, 0.4) years, 880 of 1456 individuals participated (60.4% response). The overall incidence (95% confidence interval [CI]) of C2 varicose veins was 18.2% (15.2%-21.6%), giving an annual incidence rate of 1.4% (1.1%-1.7%), with incidence rates similar in men and women: the 13-year age-adjusted incidence of varicose veins was 15.2% (10.4%-20.0%) in men and 17.4% (13.1%-21.7%) in women (P=.97). The 13-year incidence of varicose veins increased consistently with age from 9.8% in those aged 18 to 34 years to 25.7% in those aged 55 to 64 years (P< .001). The 13-year incidence (95% CI) of CVI was 9.2% (7.0%-11.9%), and the annual incidence rate was 0.7% (0.5%-0.9%). The incidence of CVI was similar in men and women and increased consistently with age (P< .001). Participants with a family history of venous disease were more likely to develop C2 varicose veins (odds ratio, 1.75; 95% CI, 1.12-2.71). Obesity was associated with the development of CVI: the 13-year incidence (95% CI) was 6.1% (3.7%-9.6%) in those who were of normal weight and 23.6% (14.2%-37.0%) in obese participants, with an age-adjusted odds ratio of 3.58 (1.70-7.56). The Edinburgh Vein Study is one of a few cohort studies to report the incidence of varicose veins and CVI in the general population. The incidence of varicose veins and CVI did not differ significantly by sex and was strongly associated with increasing age. The risk of developing varicose veins was increased in those with a family history, and the risk of CVI was increased in those with higher body mass index.

Technical procedure of two-port system subfascial endoscopic perforator vein surgery (TPS-SEPS)

It has long been noted that incompetent perforating veins contribute to the development of chronic venous insufficiency and recurrent varicose veins that are complicated by skin ulcerations or liposcleroderma. For these conditions, severing of incompetent perforating veins is an effective surgical treatment. However, severing of incompetent perforating veins by a direct approach has become less commonly performed because of the excessive invasiveness of the procedure itself. We referred to 37 cases (44 legs) of varicose veins with or without active venous dermatitis, who underwent the two-port system subfascial endoscopic perforator surgery, which we devised (hereafter referred to as TPS-SEPS). According to this method, incompetent perforating veins can be severed without surgical intervention in the lesion. The criteria for insufficiency of the perforating veins (IPVs) are reverse flow demonstrated on a color-flow duplex and a caliber more than 3 mm in diameter. One hundred forty one out of one hundred fifty two IPVs were processed. A mean of 3.21 perforating veins per patient was severed using ultrasonic coagulation-incision apparatus. From these 37 cases we conclude that TPS-SEPS provides a useful tool for the surgeon interested in treating severe chronic venous insufficiency same as the single-port technique. Our TPS-SEPS is a relatively simple operation, but its skill is dependable and provides lower invasiveness than other operation procedure. From now on, it is necessary to unify the authorized name of the endoscopic surgery of perforating veins and is also important to define the indication of this method for the primary varicose veins without stasisdermatitis.

Critical issues in preventing post-thrombotic re-ulceration

Critical issues in preventing post-thrombotic re-ulceration

Prevention and treatment of venous ulcers in primary chronic venous insufficiency

Prevention and treatment of venous ulcers in primary chronic venous insufficiency

Invited commentary

Drs Raju, Darcey, and Neglen add more information about the important role of venous obstruction to the syndrome of chronic venous insufficiency (CVI) in patients with deep venous reflux disease. From my perspective, the most important findings of this study include: venous stenting improved the rates of healed ulcers, freedom of ulcer-recurrence rates in legs with healed ulcers (C5), and freedom from leg dermatitis; venous stenting improved pain and swelling at 5 years with no differences between nonthrombotic and post-thrombotic obstructions, limbs with severe vs moderate reflux, and limbs with axial and segmental reflux; venous stenting did not result in a deterioration of reflux parameters; and deep venous reflux can be initially ignored if it is combined with iliac vein obstruction. The authors of the current study have been leaders in the area of iliac venous obstruction treatment, and they have the largest world experience using venoplasty and stenting. They used large caliber stents (14-18 mm), covered all lesions without skip areas, extended stents into the inferior vena cava (IVC) 3 to 5 cm, and extended stents below the inguinal ligament as necessary. The patients exhibited advanced chronic venous disease with all having deep venous reflux, 59% demonstrating severe global reflux, 42% showing deep axial reflux, and 65% having superficial venous reflux in addition. By intravascular ultrasound (IVUS) scan, the percent stenosis was 74%, and despite this only 43% demonstrated collaterals on venography suggesting that this venographic sign leaves much to be desired. Only a small percentage of patients required open valve reconstructions by the authors, a group that has written extensively on these vein valve procedures in the past. It is surprising that the results were so good in which only the obstructive component of the disease was treated. The authors have suggested that nonthrombotic iliac vein lesions (NIVL) play a pivotal “permissive” role in the development of chronic venous insufficiency, and the current study supports this suggestion. How can this study be put into context? As the authors suggest, “a stepwise correction of pathology may be applied using initially minimally invasive techniques.” One cannot comment on saphenous vein ablation related to iliac vein stenting from the current study as limbs with concurrent saphenous ablation performed along with stenting were excluded, as were limbs with reflux confined only to the superficial venous system. However, the current study suggests that if iliac venous obstruction is part of the pathophysiology of CVI, iliac venous stenting should be performed as first-line therapy. Unexpected major role for venous stenting in deep reflux diseaseJournal of Vascular SurgeryVol. 51Issue 2PreviewTreatment of chronic venous insufficiency (CVI) has largely focused on reflux. Minimally-invasive techniques to address superficial and perforator reflux have evolved, but correction of deep reflux continues to be challenging. The advent of intravascular ultrasound (IVUS) scan and minimally invasive venous stent technology have renewed interest in the obstructive component in CVI pathophysiology. The aim of this study is to assess stent-related and clinical outcomes following treatment by iliac venous stenting alone in limbs with a combination of iliac vein obstruction and deep venous reflux. Full-Text PDF Open Archive

Thrombus resolution and vein wall injury: dependence on chemokines and leukocytes

Chronic venous insufficiency resulting in post-thrombotic syndrome occurs commonly after acute deep vein thrombosis, and is a prevalent cause of vascular disease morbidity in the community. Therefore, a better understanding of the pathophysiologic mechanisms that promote the development of chronic venous insufficiency could lead to novel approaches to interrupt the natural history and prevent post-thrombotic syndrome. In this paper, we will review the evidence that venous thrombus resolution is an inflammatory process that is dependent on chemokines and leukocytes.