Recurrent varicose veins

Royle, John P.

doi:10.1007/bf01658645

Cited by 110 publications

(60 citation statements)

References 16 publications

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“…For example, varicose veins recur after surgery in 20-40 per cent of patients 98 . Recurrence was previously thought to be caused by poor surgical technique, especially when operations were performed by surgical trainees 99 , anatomical variability and complexity of the saphenofemoral junction 100 , and disease progression 101 . However, it is now believed that neovascularization reconnecting the venous channels is the probable cause of most recurrent disease 102,103 .…”

Section: Discussionmentioning

confidence: 99%

Pathogenesis of primary varicose veins

Lim

Davies

2009

British Journal of Surgery

238

206

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Positive family history, age, sex and pregnancy are important risk factors for varicose vein formation. Areas of intimal hyperplasia and smooth muscle cell proliferation are often noted in varicose veins, although regions of atrophy are also present. The total elastin content in varicose as opposed to non-varicose veins is reduced; changes in overall collagen content are uncertain. Matrix metalloproteinases (MMPs), including MMP-1, MMP-2, MMP-3, MMP-7 and MMP-9, and tissue inhibitor of metalloproteinase (TIMP) 1 and TIMP-3 are upregulated in varicose veins. Activation of the endothelium stimulates the recruitment of leucocytes and the release of growth factors, leading to smooth muscle cell proliferation and migration. Dysregulated apoptosis has also been demonstrated in varicose veins. An understanding of the pathophysiology of varicose veins is important in the identification of potential therapeutic targets and treatment strategies.

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Section: Discussionmentioning

confidence: 99%

Pathogenesis of primary varicose veins

Lim

Davies

2009

British Journal of Surgery

238

206

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“…Duplex scanning and hand-held Doppler are accurate for the identification of reflux sites (saphenofemoral and saphenopopliteal junctions) and recurrent disease [4][5][6][7][8][9][10][11][12][13][14]. Previous retrospective studies showed that traditional clinical examination alone was unreliable in assessing varicose veins and that Doppler and duplex are more reliable for the diagnosis of primary varicose veins [8,[11][12][13][14][15][16].…”

Section: Discussionmentioning

confidence: 99%

Is There a Need for Doppler Vascular Examination for the Diagnosis of Varicose Vein? A Prospective Study

et al. 2003

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Objective: To compare the validity of a careful clinical examination with venous Doppler studies in the management of patients presenting with varicose veins. Subjects and Methods: Ninety-five consecutive patients presenting with varicose veins from September 1998 to August 1999 were included in this study. Of the 95 patients, 52 were males and 43 females. Eighty-four were expatriate laborers and 11 Kuwaiti nationals. Seventy-one were active workers under the age of 30. All of the patients underwent a full clinical examination for varicose veins, and a management plan was developed for each patient prior to Doppler venous study. The results of the Doppler studies were then compared with the clinical examination results, and the management plan was changed, if necessary, based on the Doppler results. Results: Both clinical and Doppler examinations were equally effective in diagnosing primary varicose vein and identifying sites of venous incompetence. A family history for varicose veins was found in 21% and standing for a long period of time was a risk factor in 51% patients. The most common symptoms were pain and heaviness. Doppler study findings were useful in changing the management plan of 14 (15%) patients, 6 with recurrent varicose vein and 8 obese patients with chronic venous insufficiency. The majority of the patients (n = 82) benefited from surgery and were free of symptoms. Conclusion: This prospective study demonstrated that detailed clinical examination was sufficient to diagnose most patients suffering from primary varicose veins. Doppler vascular studies were useful in changing the treatment modality for those presenting with recurrent varicose vein or obese patients with signs and symptoms of chronic venous insufficiency with no clinically clear varicosity.

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“…5 Various suggestions have been made for the cause of this high rate of recurrence, including poor surgical technique, particularly by junior surgeons in training 6 ; anatomic variability and complexity of the SFJ 7 ; and persistent progressive venous disease. 1 However, it is now believed that the most common cause of this recurrence is angiogenesis with new vessel formation and reconnection of the venous channels.…”

Section: Clinical Perspective P 74mentioning

confidence: 99%

Mechanical Inhibition of Angiogenesis at the Saphenofemoral Junction in the Surgical Treatment of Varicose Veins

et al. 2008

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Background-Saphenofemoral junction (SFJ) ligation has been a major component of surgical intervention for varicose veins; however, recurrence occurs in as many as 40%. Neovascularization with reconnection of the venous channels at the transected SFJ has been identified as the major cause of this recurrence. This randomized controlled study sought to evaluate mechanical suppression of neovascularization at the SFJ, with the use of a synthetic patch, to prevent recurrence after ligation surgery. Methods and Results-A total of 389 limbs (from 292 patients) were randomized into either control (SFJ ligation surgery) or patch (SFJ ligation with polytetrafluoroethylene patch of the transected SFJ) groups. All patients underwent clinical assessment, duplex imaging, and air plethysmography studies preoperatively and at 1, 6, 12, and 36 months postoperatively. The patch consistently halved the recurrence rate to 3 years postoperatively in all clinical subgroups. In those patched SFJs that still developed recurrence, evidence of neovascularization circumventing the polytetrafluoroethylene patch was observed by both ultrasound and histology. Conclusions-This study demonstrates that use of a polytetrafluoroethylene patch is an effective mechanical suppressant of neovasculogenesis at the SFJ and can be safely used as a strategy to improve long-term outcome of varicose vein surgery. (Circulation. 2008;118:66-74.)

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Recurrent varicose veins

Cited by 110 publications

References 16 publications

Pathogenesis of primary varicose veins

Pathogenesis of primary varicose veins

Is There a Need for Doppler Vascular Examination for the Diagnosis of Varicose Vein? A Prospective Study

Mechanical Inhibition of Angiogenesis at the Saphenofemoral Junction in the Surgical Treatment of Varicose Veins

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