Clinicopathological evidence that neovascularisation is a cause of recurrent varicose veins

Nyamekye, Isaac; Shephard, Nicholas; Davies, B.; Heather, B. P.; Earnshaw, J. J.

doi:10.1016/s1078-5884(98)80202-5

Cited by 136 publications

(121 citation statements)

References 18 publications

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“…11 In 70% of cases, this has been due to groin neovascularisation, secondary to angiogenesis of the postoperative reparation following groin dissection. 11,12 Recurrence rates at two years in endovenous ablation remain under 7% at present. 13 Untreated refluxing tributaries (accessory saphenous vein or duplex saphenous system) and refluxing perforators increase the risk of recurrence but are uncommon (<5%).…”

Section: Discussionmentioning

confidence: 97%

Single-visit endovenous laser treatment and tributary procedures for symptomatic great saphenous varicose veins

Alder

Rahi

2014

annals

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INTRODUCTION Endovenous ablation of saphenous varicose veins has decreased morbidity and recovery time compared with open surgery. This study assessed the outcome and mid-term patient satisfaction of single-visit endovenous laser treatment (EVLT) alone, EVLT combined with phlebectomies and endovenous chemical ablation. METHODS A retrospective review was conducted of all patients (n=91) in 2008-2009 who underwent single-visit day-case EVLT using local anaesthesia under a single surgeon. Postoperative venous ultrasonography at 2 and 14 months was reviewed. A telephone questionnaire was carried out to assess recurrence of symptoms and quality of life at 42 months. RESULTS Overall, 124 limbs underwent day-case EVLT under local anaesthesia using an 810nm diode laser at a continuous setting of 14W. Forty-eight of these underwent EVLT alone while fifty underwent EVLT with phlebectomies and twenty-six underwent EVLT with endovenous chemical ablation. Ninety-one per cent of limbs underwent two-month postoperative imaging. All had satisfactory great saphenous vein (GSV) ablation (anterior thigh vein patency: n=1). The majority (84%) of limbs underwent 14-month imaging with a 98% GSV ablation rate. Three per cent had anterior thigh vein and saphenofemoral junction incompetence. Recurrence of GSV patency and reflux was <1%. The response rate to the questionnaire was 60%: 95% of respondents confirmed improvement following treatment, 62% remained symptom free at 42 months while 65% of patients with a return of symptoms deemed them mild. The questionnaire was scored out of 56 for symptoms and quality of life. Those with symptoms scored significantly higher. CONCLUSIONS At 42 months, the majority of limbs remained asymptomatic. The short-term GSV ablation rates were excellent. Overall mid-term review of patients has shown a well received single-visit service with concomitant phlebectomy or endovenous ablation, and good ablation and patient satisfaction rates.

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Section: Discussionmentioning

confidence: 97%

Single-visit endovenous laser treatment and tributary procedures for symptomatic great saphenous varicose veins

Alder

Rahi

2014

annals

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“…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

231

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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“…Neovascularization is thought to be the result of angiogenesis following the tissue trauma of surgical dissection 29 , whereas it is speculated that extravenous inflammation does not occur following EVLA. It has been suggested that the preservation of groin tributaries during EVLA avoids the stimulus for angiogenesis 40 ; some surgeons even preserve groin tributaries during saphenofemoral ligation on this basis 41 .…”

Section: Discussionmentioning

confidence: 99%

Clinical and technical outcomes from a randomized clinical trial of endovenous laser ablation compared with conventional surgery for great saphenous varicose veins

Carradice

Mekako

Mazari

et al. 2011

British Journal of Surgery

107

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Clinicopathological evidence that neovascularisation is a cause of recurrent varicose veins

Abstract: Neovascularisation was the principal cause of recurrent saphenofemoral incompetence in this series.

Cited by 136 publications

References 18 publications

Single-visit endovenous laser treatment and tributary procedures for symptomatic great saphenous varicose veins

Single-visit endovenous laser treatment and tributary procedures for symptomatic great saphenous varicose veins

Pathogenesis of primary varicose veins

Clinical and technical outcomes from a randomized clinical trial of endovenous laser ablation compared with conventional surgery for great saphenous varicose veins

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