Abstract:A lack of overlap exists between the finding of a PV outward flow lasting more than 500 ms and the net outward flow of the same vessel. The traditional definition of PV incompetence is challenged by the reported data and further investigations are required to identify a gold standard assessment.
“…This multi-gate scanning reported a sensitivity of the perforating vein incompetence of just 13.9%, with a specificity of 96.4%. 24 In the same year, Bechsgaard et al published data supporting the use of another angle independent spectral analysis (vector flow imaging method) and reported an equally precise but far more accurate flow assessment than with routine duplex ultrasound investigation of perforating veins. 25 2.…”
Section: Global Uip 2011mentioning
confidence: 99%
“…This multi-gate scanning reported a sensitivity of the perforating vein incompetence of just 13.9%, with a specificity of 96.4%. 24…”
Guidelines are fundamental in addressing everyday clinical indications and in reporting the current evidence-based data of related scientific investigations. At the same time, a spatial and temporal issue can limit their value. Indeed, variability in the recommendations can be found both among the same nation different scientific societies and among different nations/continents. On the other side, Garcia already published in 2014 data showing how, after three years in average, one out of five recommendations gets outdated (Martinez Garcia LM, Sanabria AJ, Garcia Alvarez E, et al. The validity of recommendations from clinical guidelines: a survival analysis. CMAJ 2014;186(16):1211–1219). The present document reports a narrative literature revision on the major international recommendations in lower limb venous and lymphatic disease management, focusing on the different countries’ guidelines, trends and controversies from all the continents, while identifying new evidence-based data potentially influencing future guidelines. World renowned experts’ opinions are also provided. The document has been written following the recorded round tables scientific discussions held at the vWINter international meeting (22–26 January 2019; Cortina d’Ampezzo, Italy) and the pre- and post-meeting literature search performed by the leading experts.
“…This multi-gate scanning reported a sensitivity of the perforating vein incompetence of just 13.9%, with a specificity of 96.4%. 24 In the same year, Bechsgaard et al published data supporting the use of another angle independent spectral analysis (vector flow imaging method) and reported an equally precise but far more accurate flow assessment than with routine duplex ultrasound investigation of perforating veins. 25 2.…”
Section: Global Uip 2011mentioning
confidence: 99%
“…This multi-gate scanning reported a sensitivity of the perforating vein incompetence of just 13.9%, with a specificity of 96.4%. 24…”
Guidelines are fundamental in addressing everyday clinical indications and in reporting the current evidence-based data of related scientific investigations. At the same time, a spatial and temporal issue can limit their value. Indeed, variability in the recommendations can be found both among the same nation different scientific societies and among different nations/continents. On the other side, Garcia already published in 2014 data showing how, after three years in average, one out of five recommendations gets outdated (Martinez Garcia LM, Sanabria AJ, Garcia Alvarez E, et al. The validity of recommendations from clinical guidelines: a survival analysis. CMAJ 2014;186(16):1211–1219). The present document reports a narrative literature revision on the major international recommendations in lower limb venous and lymphatic disease management, focusing on the different countries’ guidelines, trends and controversies from all the continents, while identifying new evidence-based data potentially influencing future guidelines. World renowned experts’ opinions are also provided. The document has been written following the recorded round tables scientific discussions held at the vWINter international meeting (22–26 January 2019; Cortina d’Ampezzo, Italy) and the pre- and post-meeting literature search performed by the leading experts.
“…It has also been suggested though that the existence of bidirectional flow in perforators may be normal and is not necessarily an essential requirement of the genesis of venous hypertension and venous disease. [2][3][4][5] The proposal is that bidirectional flow allows quick equilibration of pressure changes between deep and superficial veins during ambulation in both varicose vein patients and healthy individuals. The implication of this is that calf perforators are essentially incompetent and the bidirectional flow within them is a normal, physiological feature.…”
mentioning
confidence: 99%
“…When tested more physiologically with foot movement valve closure may be more discrete (Figure 3). 5,12 This outward ‘wisp’ in a well-functioning valve is physiological but should not be considered incompetence nor be called bidirectional, as these terms implicate that there is no valve or the valve is dysfunctional. In contrast, when there is valve incompetence the pathophysiological outward flow with cuff relaxation is distinctively more prolonged (generally considered reflux at >350 ms 23 or >500 ms 7 ).Figure 3.Perforator flow velocity changes during isometric plantar flexion illustrating brief ‘flicker’ of flow reversal as valve closes with flex followed by no flow during contraction, and inflow on release.…”
The suggestion that bidirectional flow is a normal feature seen in venous perforators of the lower leg has been a longstanding debate. Newer published evidence has changed the perspective on normal perforator flow and is presented here to resolve the misunderstandings and different viewpoints previously held.
Normal veins could develop to varicose vein (VV) by some risk factors, and might further progress to shallow vein thrombosis (SVT). However, the molecular mechanism of key genes associated with the progression and regression of VV are still not thorough enough. In this study, the healthy control (HC), VV, and SVT vascular samples were collected for transcriptome sequencing. The differentially expressed genes (DEGs) were screened by “DESeq2”, including DEGs1 (HC vs. VV), DEGs2 (HC vs. SVT) and DEGs3 (VV vs. SVT). And their functional enrichment analyses were conducted by “ClusterProfiler”. The receiver operating characteristic (ROC) curve was used to obtain the key genes (KGs) of the pathogenesis of VV and SVT. The qRT-PCR assay was performed to validate the expressions of KGs. Immune cell infiltration analyses were conducted based on ssGSEA method. The competitive endogenous RNAs (ceRNAs) regulatory network was constructed. The target drugs of KGs were predicted using DrugBank database. The biofunctions of DACT3 were further investigated through a series of experiments in vitro. All of these DEGs were associated with inflammation and immunity related functions. Immune cell infiltration was significantly different between VV and SVT. Six key genes including PLP2, DACT3, LRRC25, PILRA, MSX1 and APOD that were associated with the progression and regression of VV were screened. The expression of LRRC25 and PILRA was significantly negatively associated with central memory T cell, and significantly positively associated with B cell. Besides, XIST was the critical regulator of multiple KGs. Cimetidine was potential drug for VV and SVT therapy. Overexpression of DACT3 significantly inhibited the proliferation and migration of vascular smooth muscle cells (VSMCs), and affected their cell cycle and phenotypic transition. This study identified six key genes associated with the progression and regression of VV. Among them, DACT3 was proved to hinder VV progression. These findings may help to deepen understanding its underlying mechanisms.
Supplementary Information
The online version contains supplementary material available at 10.1038/s41598-024-73691-3.
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