Contrasting Effects of Varicose Vein Surgery on Endothelial-dependent and -independent Cutaneous Vasodilation in the Perimalleolar Region

Abstract

Sapheno-femoral ligation and partial stripping in patients with great saphenous vein insufficiency improves endothelial-independent cutaneous vasodilator function at the gaiter area, which may at least partly explain the benefits of surgery in reducing the risk of venous ulceration.

Impaired microvascular endothelial function is restored by acute lower-limb exercise in post-surgical varicose vein patients

“…2 upper panel). This finding is consistent with previous reports that microvascular endothelial function in the standing position is relatively depressed in patients with isolated superficial venous insufficiency compared to healthy age-matched controls (Klonizakis et al, 2003), and that venous surgery has no effect on microvascular endothelial function (Klonizakis et al, 2006). Vascular integrity in the healthy endothelium is maintained through the release of a variety of paracrine factors, such as NO.…”

“…2 lower panel). These findings are consistent with previous reports that microvascular endothelial-independent function in the standing position is similar between varicose vein patients and healthy age-matched controls (Klonizakis et al, 2003), and that varicose vein surgery enhances cutaneous responsiveness to SNP (Klonizakis et al, 2006). The higher SNP responses of patients in the standing position are consistent with a reduction in the venoarteriolar reflex following surgery, i.e., less activation of local neurovascular pathways that cause vascular smooth muscle contraction and oppose the effects of SNP.…”

“…The higher SNP responses of patients in the standing position are consistent with a reduction in the venoarteriolar reflex following surgery, i.e., less activation of local neurovascular pathways that cause vascular smooth muscle contraction and oppose the effects of SNP. A reduction in the venoarteriolar reflex might be explained by differences in venous pressure as a result of surgery, or by changes in the sensory or effector arms of the reflex pathway, including down-regulation of cutaneous vasoconstrictor mechanisms (Klonizakis et al, 2006). Extracellular matrix remodelling is one of several mechanisms that might affect the balance of vasodilator and vasoconstrictor responses of the blood vessel wall (Kowalewski et al, 2004).…”

“…Despite these benefits, the recurrence rates for varicose veins (20.7% over an 11 yr period; Winterborn et al, 2004) and venous ulcers (18% over a 5 yr period; Nelzen and Fransson, 2007) remain relatively high. The latter might be explained, at least in part, by microvascular endothelial dysfunction that persists following surgery (Klonizakis et al, 2003;Klonizakis et al, 2006). Therefore, it appears important to identify strategies to improve microvascular endothelial function in this population.…”

“…A secondary aim was to investigate whether any impairment of function can be alleviated by acute lower-limb exercise. In view of the existing literature (Klonizakis et al, 2003;Klonizakis et al, 2006), we hypothesised that, before acute exercise, microvascular endothelial function would be relatively depressed in patients compared to controls. Secondly, that any baseline impairment of microvascular endothelial vasodilator function would be attenuated by acute lower-limb exercise.…”