scholarly journals Are bacteria the main pathological factor in pathogenesis of lower limb varicose veins and non-healing ulcers?

2019 ◽  
Vol 4 (2) ◽  
Author(s):  
Waldemar L Olszewski ◽  
Marzanna T Zaleska ◽  
Ewa Stelmach
Keyword(s):  
Immune Response ◽  
Lymph Nodes ◽  
Granulation Tissue ◽  
Saphenous Vein ◽  
Lower Limb ◽  
Varicose Veins ◽  
Venous Stasis ◽  
Vein Wall ◽  
Delayed Healing ◽  
Primary Damage

Why do the saphenous vein varices arise? According to our concept this is a process of slow deconstruction of the vein wall by inflammation caused by microbes penetrating plantar skin, colonizing deep tissues, entering veins and sticking to valves, as well as, transported to lymphatics, bringing about damage to their wall and evoking immune response in the inguinal lymph nodes. Venous stasis caused by a variety of hemodynamic factors remains secondary to the primary damage of the vein wall. With respect to ulcer, irrespective of the predisposing factors as venous stasis, colonization of the denuded calf surfaces takes place by bacteria drained from foot skin and also those floating down to calf from the perineum. This set of microbes is responsible for progression of ulcer or its delayed healing. In this study, the numerical phenotypes of varicose veins and ulcer granulation tissue bacteria were presented. The dominant strains in the vein walls were Staph. epidermidis and aureus with Enterococci and Pseudomonas frequent in ulcers. High percentage of Staphylococci both in vein walls and ulcer sensitive to antibiotics may suggest that they originated from the microbiome inhabiting leg tissues prior to the development of varices and ulcer.

scholarly journals Chronic venous insufficiency after COVID-19: management of edema and pain syndromes

2021 ◽  
Vol 18 (2) ◽  
pp. 151-153
Author(s):  
F. Kh. Nizamov
Keyword(s):  
Chronic Diseases ◽  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Clinical Symptoms ◽  
Varicose Veins ◽  
Clinical Manifestations ◽  
Pain Syndrome ◽  
Venous Stasis ◽  
Vein Wall ◽  
Vas Scores

Introduction. COVID-19 infection raises many questions regarding the health condition of patients after they have had COVID-19. The aim of this study is to examine the characteristic symptoms of chronic venous insufficiency in the postcovid period.Materials and methods. The materials that were used for work included the results of studying the medical aid appealability, characteristic symptoms, diagnosis and treatment of symptoms of chronic venous insufficiency in persons who have had the coronavirus infection. 47 patients presented with complaints about deterioration of their condition after they had had COVID-19 over March to September 2021 period. Methods: general clinical examiniation, ultrasound angioscanning of veins of the lower extremities, laboratory coagulation tests.Results and discussion. Before deterioration, calf circumference was measured 22–24 cm at a typical measurement site in most patients (89%), after covid infection it reached 26–27 cm. Varicose veins remained soft, without intravascular formations, edema was often bilateral, asymmetric, pain was described as constant (5–6 VAS scores), patients had prominent signs of lymphostasis. 35 out of 47 people received diosmin-based venotonic drug of Russian manufacture at a dose of 1000 mg/day (one tablet twice a day), the course of treatment lasted one to two months. After that period, the edema subsided in 85% of patients, the severity of pain syndrome significantly reduced (up to 2–3 VAS scores). With regard to chronic venous insufficiency in patients with chronic diseases of lower extremity veins (mostly varicose and post-thrombotic diseases), the significant progress of disease was observed in almost 94% of follow-up cases. Diosmin is the main drug that is prescribed to treat chronic venous insufficiency. The drug has an angioprotective and venotonic effect, reduces the vein wall elasticity, increases venous tone, and decreases venous stasis, reduces capillary permeability and fragility, and increases their resistance, improves microcirculation and lymphatic drainage.Сonclusions. In the postcovid period, clinical symptoms of some chronic diseases occur/worsen, including clinical manifestations of chronic venous insufficiency. The use of Russian diosmin-based drug for the management of edema and pain syndrome is very promising.

Changes in Metalloproteinase (MMP-1, MMP-2) Expression in the Proximal Region of the Varicose Saphenous Vein Wall in Young Subjects

2000 ◽  
Vol 15 (2) ◽  
pp. 64-70 ◽  
Author(s):  
J. Buján ◽  
F. Jurado ◽  
M. J. Gimeno ◽  
N. García-Honduvilla ◽  
G. Pascual ◽  
...  
Keyword(s):  
Saphenous Vein ◽  
Varicose Vein ◽  
Healthy Subjects ◽  
Varicose Veins ◽  
Young Patients ◽  
Proximal Region ◽  
Vein Wall ◽  
Immunohistochemical Markers ◽  
Young Subjects ◽  
Process Characteristic

Objective: An evaluation of the proteoglycan perlecan, collagen I and III, and metalloproteinases MMP−1, −2, −3 and −9 was performed to explore the possible relationships between ageing, affected vein region and reactive state of the varicose vein wall. Methods: Segments of saphenous vein were obtained from healthy subjects and from those with varicose veins. The vein specimens were subdivided according to subject age (<50/^50) and vein source (distal/proximal). Results: The walls of control vein specimens acquired a more collagenous appearance with age. These changes were not accompanied by significant modifications in the immunohistochemical markers used. In specimens from young patients, proximal varicose vein segments showed an increase in MMP-1, MMP-2 and MMP-9 expression. Subjects of more advanced age showed an increase in perlecan expression. Conclusion: This increase in MMPs could lead to the acceleration of the final fibrosclerotic process characteristic of the varicose vein wall.

Arteries masquerading as varicose veins: A trap for phlebologists

2014 ◽  
Vol 30 (10) ◽  
pp. 729-735 ◽  
Author(s):  
L Jones ◽  
K Parsi
Keyword(s):  
Saphenous Vein ◽  
Lower Limb ◽  
Varicose Veins ◽  
Duplex Ultrasound ◽  
Tissue Loss ◽  
Injection Sclerotherapy ◽  
Ultrasound Guided ◽  
History Of ◽  
The Right

Ultrasound guided sclerotherapy may be complicated by intra-arterial injections resulting in significant tissue necrosis. Here, we present a 69-year-old man with a history of right small saphenous vein “stripping”, presenting for the treatment of symptomatic lower limb varicose veins. Duplex ultrasound of the right lower limb outlined the pathway of venous incompetence. Despite the history of “stripping”, the small saphenous vein was present but the sapheno-popliteal junction was ligated at the level of the knee crease. No other unusual findings were reported at the time. During ultrasound guided sclerotherapy, subcutaneous vessels of the right posterior calf were noted to be pulsatile on B-mode ultrasound. Treatment was interrupted. Subsequent angiography and sonography showed absence of the right distal popliteal artery. A cluster of subcutaneous vessels of the right medial and posterior calf were found to be arterial collaterals masquerading as varicose veins. Injection sclerotherapy of these vessels would have resulted in significant tissue loss. This case highlights the importance of vigilance at the time of treatment and the invaluable role of ultrasound in guiding endovenous interventions.

Bloodless removal of varicose veins - a new technique

2004 ◽  
Vol 19 (4) ◽  
pp. 185-188 ◽  
Author(s):  
D Lorenz ◽  
W Kullich ◽  
M Redtenbacher ◽  
W Weissenhofer
Keyword(s):  
Saphenous Vein ◽  
Lower Limb ◽  
High Frequency ◽  
Varicose Veins ◽  
Subcutaneous Tissue ◽  
Compression Bandages ◽  
Standard Procedures ◽  
Added Benefit ◽  
Preliminary Study ◽  
A New Technique

Objective: To describe the use of a novel electric vein stripper (EVS) for use in patients with varicosities of the greater saphenous vein and tributaries. Methods: In addition to standard procedures as performed in varicose veins of the lower limb, an EVS, powered by a standard high frequency electrocoagulation generator (HF), is introduced. The application of this new EVS makes it possible to avoid tearing of the structures of the subcutaneous tissue surrounding the greater saphenous vein, leaving the channel of the vein blood dry. Results: A preliminary study including two groups of patients - 20 in the Babcock group and 24 in the EVS group - resulted in significantly reduced pain and discomfort. An added benefit for the patients was the fact that postoperative compression bandages were not needed. Conclusions: Application of EVS can prevent bruising and haematomas in vein stripping can be avoided.

The venous valve agger and plasma noradrenaline-mediated venodilator feedback

2007 ◽  
Vol 22 (3) ◽  
pp. 116-130 ◽  
Author(s):  
T P Crotty
Keyword(s):  
Saphenous Vein ◽  
Varicose Veins ◽  
Feedback Effect ◽  
Venous Valve ◽  
Venous Tone ◽  
Vein Wall ◽  
University Departments ◽  
Perfusion Studies

Objective: To investigate the structure and function of the venous valve agger, a fibroelastic structure located at the base of every valve in veins that are responsive to noradrenaline (NA). Design: Constant flow perfusion studies of the responses of in situ and in vitro canine lateral saphenous vein segments to NA and electrical stimulation, supplemented by histological studies of the segments. Setting: University Departments of Physiology and Histology. Materials: Segments of canine lateral saphenous vein. In vitro = 84, in situ = 60 plus. Results: The agger is a crescentic fibroelastic sleeve, spanning the vein wall very obliquely through which the local vasa venarum network drains. It has a dedicated musculature which, when the tone rises, contracts and stretches the fibroelastic of the agger and opens the drainage channels to reflux. Each agger has four muscles, two each of which insert on the concave and convex margins of the agger. They pull in opposite directions when they contract. Conclusions: The agger forms part of a complex that, in conjunction with its dedicated musculature, a reversible transmural pressure gradient and physiological turbulence in the valve sinuses, positively facilitates drainage from the local segment of the vasa venarum network when venous tone is normal; and when venous tone is elevated it pumps and sucks blood from the lumen of the vein to perfuse the vasa venarum network. When the plasma NA in the perfusate diffuses from the network, it causes a localized venodilator feedback effect that restores the elevated tone of the vein to normal. The feedback effect is potent, being estimated to reduce the venonstrictor effect of neuronal NA by about 50% when flow is laminar and considerably more when flow is turbulent. There is evidence that plasma NA may constitute the lateral inhibitory component of the NA chemostimulus of the smooth muscle cell, neuronal NA constituting the excitor component. A chronic breakdown in agger function is believed to be the cause of varicose veins.

scholarly journals Diagnosis of stenosis within the popliteal–femoral venous segment upon clinical presentation with a venous ulcer and subsequent successful treatment with venoplasty

2017 ◽  
Vol 5 ◽  
pp. 2050313X1774051
Author(s):  
Emma Dabbs ◽  
Alina Sheikh ◽  
David Beckett ◽  
Mark S Whiteley
Keyword(s):  
Saphenous Vein ◽  
Lower Limb ◽  
Varicose Veins ◽  
Venous Ulcer ◽  
Distal Region ◽  
Duplex Ultrasonography ◽  
Venous Ulceration ◽  
Venous Collaterals ◽  
The Right ◽  
Venous Segment

This case study reports the diagnosis and treatment of a lower limb venous ulcer with abnormal underlying venous pathology. One male patient presented with bilateral varicose veins and a right lower limb ulcer. Upon investigation, full-leg duplex ultrasonography revealed total incompetence of the great saphenous vein in the left leg. In the right leg, duplex ultrasonography showed proximal incompetence of the small saphenous vein, and dilation of the anterior accessory saphenous vein, which remained competent. Incidentally, two venous collaterals connected onto the distal region of both these segments, emerging from a scarred, atrophic popliteal–femoral segment. An interventional radiologist performed venoplasty to this popliteal–femoral venous segment. Intervention was successful and 10 weeks post procedure ulceration healed. Popliteal–femoral venous stenosis may be associated with venous ulceration in some cases and may be successfully treated with balloon venoplasty intervention.

scholarly journals Saphenous Ladder Formed by Almost Completely Duplicated Great Saphenous Vein

2020 ◽  
Vol 18 (1) ◽  
pp. 99-101
Author(s):  
Vasanthakumar Packiriswamy ◽  
Satheesha B Nayak
Keyword(s):  
Saphenous Vein ◽  
Lower Limb ◽  
Great Saphenous Vein ◽  
Varicose Veins ◽  
Femoral Vein ◽  
Saphenous Veins ◽  
Left Lower Limb ◽  
Male Cadaver ◽  
Complete Duplication ◽  
Femoral Triangle

Knowledge of normal as well as variant great saphenous vein is useful as it is the vein that can get varicosed; the vein that is used in bypass surgeries and the vein that is used for cannulation purpose. We observed almost complete duplication of the great saphenous vein in the left lower limb of an adult male cadaver. Both the great saphenous veins arose from the medial end of the dorsal venous arch and coursed parallel to each other throughout the limb. They united in the femoral triangle to form a short (1 inch long) common great saphenous vein. Common great saphenous vein terminated into the femoral vein. There were four communicating veins connecting the two great saphenous veins in the leg, giving the appearance of a venous ladder. Knowledge of this variation could be extremely useful in treatment of varicose veins of lower limb, in catheterizations and in various surgical procedures of the lower limb.

scholarly journals Clinical, ultrasonographic and histological findings in varicose vein surgery

2018 ◽  
Vol 64 (8) ◽  
pp. 729-735
Author(s):  
Moacir de Mello Porciunculla ◽  
Dafne Braga Diamante Leiderman ◽  
Rodrigo Altenfeder ◽  
Celina Siqueira Barbosa Pereira ◽  
Alexandre Fioranelli ◽  
...  
Keyword(s):  
Saphenous Vein ◽  
Varicose Vein ◽  
Lower Limb ◽  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Great Saphenous Vein ◽  
Varicose Veins ◽  
Clinical Severity ◽  
Clinical Classification ◽  
Histopathological Changes

SUMMARY OBJECTIVE This study aims to correlate the demographic data, different clinical degrees of chronic venous insufficiency (CEAP), ultrasound findings of saphenofemoral junction (SFJ) reflux, and anatomopathological findings of the proximal segment of the great saphenous vein (GSV) extracted from patients with primary chronic venous insufficiency (CVI) submitted to stripping of the great saphenous vein for the treatment of lower limb varicose. METHOD This is a prospective study of 84 patients (110 limbs) who were submitted to the stripping of the great saphenous vein for the treatment of varicose veins of the lower limbs, who were evaluated for CEAP clinical classification, the presence of reflux at the SFJ with Doppler ultrasonography, and histopathological changes. We study the relationship between the histopathological findings of the proximal GSV withdrawal of patients with CVI with a normal GSV control group from cadavers. RESULTS The mean age of the patients was higher in the advanced CEAPS categories when comparing C2 (46,1 years) with C4 (55,7 years) and C5-6(66 years), as well as C3 patients (50,6 years) with C5-6 patients. The normal GSV wall thickness (mean 839,7 micrometers) was significantly lower than in the saphenous varicose vein (mean 1609,7 micrometers). The correlational analysis of reflux in SFJ with clinical classification or histopathological finding did not show statistically significant findings. CONCLUSIONS The greater the age, the greater the clinical severity of the patients. The GSV wall is thicker in patients with lower limb varicose veins, but those histopathological changes are not correlated with the disease’s clinical severity or reflux in the SFJ on a Doppler ultrasound.

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