Primary varicose veins: The sapheno-femoral junction, distribution of varicosities and patterns of incompetence

Cooper, DG; Hillman-Cooper, C.S.; Barker, S. G. E.; Hollingsworth, Simon J.

doi:10.1053/ejvs.2002.1782

Cited by 56 publications

(45 citation statements)

References 17 publications

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“…Cooper et al reported that primary varicose veins are a result of primary wall abnormality predisposing to venous dilatation, as a precursor to later valvular incompetence and finally reflux (40). Because this incompetence predominates in areas that would not be anticipated to suffer the greatest pressures, a more complex interaction between luminal forces, and perhaps an unidentified molecular "signal" for vessels to dilate, may be fundamental to the genesis of varicose veins.…”

Section: Discussionmentioning

confidence: 99%

Cardiovascular evaluation of young patients with varicocele

Kılıç

Aksoy

Sıncer

et al. 2007

Fertility and Sterility

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Section: Discussionmentioning

confidence: 99%

Cardiovascular evaluation of young patients with varicocele

Kılıç

Aksoy

Sıncer

et al. 2007

Fertility and Sterility

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“…Indeed, the reversibility of the GSV reflux was reported by Quill and Fegan (24) long time ago following compression sclerotherapy. In addition to these studies, several publications have challenged the theory of descending progression, citing the possibility of local or multifocal early distal evolution (ascending) based on detailed duplex scanning (1)(2)(3)(4)(5). A recent report based on 2,275 duplex scanning results showed reflux that appeared to progress in an ascending manner from the superficial tributaries to the SV and then to the SFJ (5).…”

Section: Discussionmentioning

confidence: 99%

The endovenous ASVAL method: principles and preliminary results

Atasoy

Oğuzkurt²

2015

Diagn Interv Radiol

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A mbulatory selective varicose vein ablation under local anesthesia (ASVAL) is a surgical treatment for varicose veins based on the ascending hypothesis that venous insufficiency progresses in an ascending manner, from the superficial tributaries to the saphenous vein (SV) and then to the sapheno-femoral junction (SFJ). Recent scientific data based on precise and detailed duplex scanning support this hypothesis (1-6). The ASVAL method recommends preserving the great saphenous vein (GSV), unless there is a serious terminal valve insufficiency, and suggests the surgical removal (phlebectomy) of the superficial varicose reservoir (SVR) as a primary treatment. The major argument in favor of preserving the GSV is the essential physiologic role that the GSV could play in superficial drainage and, to a lesser extent, its availability as revascularization material. Although the original ASVAL method is performed using simple phlebectomies, many patients refuse to have this treatment because they regard it as a surgical operation that would likely yield poor cosmetic results. Thermal endovenous techniques and foam sclerotherapy are less aggressive and are reported to be as effective as traditional surgical treatments (7). The question arises as to whether the ASVAL approach can be performed using endovenous techniques. To the best of our knowledge, this research will be a preliminary study describing the endovenous technique for the ASVAL approach.The purpose of this study was to investigate the feasibility and safety of endovenous ASVAL (eASVAL) technique and to present the short-term results with one-year ultrasonography (US) follow-up in a selected group of patients. PURPOSEWe aimed to investigate the feasibility and safety of the endovenous ambulatory selective varicose vein ablation under local anesthesia (eASVAL) method in a selected group of pa tients with varicose disease and present the short-term results of one-year ultrasonographic follow-up. METHODSThree hundred and ninety-five consecutive patients with varicose veins who had been treated with endovenous laser ablation (EVLA) were retrospectively reviewed over a period of two years. From this group, 41 patients who were treated using the eASVAL technique and had the great saphenous vein (GSV) preserved were included in the study. These patients had only limited segmental GSV reflux accompanied by a competent terminal valve. The eASVAL technique can be defined as EVLA of the proximal straight segments of the major tributaries connecting the symptomatic varicose veins with the GSV, followed by ultrasound-guided foam sclerotherapy of the superficial varicose veins themselves. The patients were assessed before and after the treatment by duplex scan findings and clinical assessment scores. RESULTSThe GSVs were successfully preserved in all 41 cases, and all patients showed significant clinical improvement using the eASVAL approach (P < 0.001). Segmental reflux was no longer present in 75.3% of patients. The mean diameters of the GSVs were significantly reduced at...

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“…Since these changes may influence the study results, all the examinations in this study were performed in a single point, the saphenofemoral joint, which is a physiopathologically important location. The presence of reflux in the saphenofemoral junction causes the varices to be more disseminated (25). Furthermore, reflux is more frequent at the saphenofemoral junction in advanced stage patients (26).…”

Section: Discussionmentioning

confidence: 99%

Does extracellular matrix of the varicose vein wall change according to clinical stage?

Demirkıran¹,

Köksoy

Heper

et al. 2014

UCD

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Objective:The etiology and pathophysiology of chronic venous disease is not fully understood. This study aimed to determine the variation of the extracellular matrix proteins in varicose vein wall according to clinical stage. Material and Methods:Forty varicose and 10 control veins were sampled from the saphenofemoral junction. The Clinical Etiologic Anatomic Pathophysiologic (CEAP) classification was used in patients with varicose veins. Samples were stained with hematoxylin-eosin, Masson's trichrome, EVG (Elastica-van Gieson) stain and with laminin, fibronectin, tenascin antibodies. Stained samples were examined immuno-histochemically. Changes in extracellular matrix were determined semi-quantitatively using light microscopy. Results:It was observed that in the early stages (C2-C3) of chronic venous disease, fibrosis is increased in the intima and media layers, with fragmentation in lamina elastica interna, and increased tenascin expression in the intima layer. In advanced stages (C4-C6), the accumulation of tenascin in the intima continued along with fibrosis in the media layer, the thickness of the media layer increased and fibronectin deposition was observed. Conclusion:This study showed that changes first occur in the intima during the early stages of the disease with addition of alterations in the media layer at later stages.

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Primary varicose veins: The sapheno-femoral junction, distribution of varicosities and patterns of incompetence

Abstract: primary VVs develop in isolated segments of the superficial venous system (without connection to the deep system) at, or distal to, the underlying main trunk incompetence, suggesting a process of "spreading incompetence" from one focal point, producing varicosities (mainly in tributaries).

Cited by 56 publications

References 17 publications

Cardiovascular evaluation of young patients with varicocele

Cardiovascular evaluation of young patients with varicocele

The endovenous ASVAL method: principles and preliminary results

Does extracellular matrix of the varicose vein wall change according to clinical stage?

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