Recurrent varicose veins: A national problem

Negus, David

doi:10.1002/bjs.1800800705

Cited by 88 publications

(44 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…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

231

206

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

Pathogenesis of primary varicose veins

Lim

Davies

2009

British Journal of Surgery

231

206

View full text Add to dashboard Cite

show abstract

“…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

View full text Add to dashboard Cite

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.)

show abstract

“…The recurrence rate is much higher with a longer follow-up, with a study by Fischer et al documenting a recurrence rate as high as 77 % with a 34-year follow-up [3]. It is estimated that in UK, out of the total surgeries performed for varicose veins, 20 % are for recurrent disease and technically, it is more demanding [4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Role of PTFE Patch Saphenoplasty in Reducing Neovascularization and Recurrence in Varicose Veins

et al. 2014

View full text Add to dashboard Cite

Varicose veins have a high recurrence rate following surgery. Besides poor surgical technique, majority of these recurrences are attributable to neovascularization after both primary and repeat surgery. Authors have studied the effectiveness of a polytetrafluoroethylene (PTFE) patch interposition between the ligated vein stump and the overlying soft tissue at saphenofemoral junction in decreasing recurrence of varicose veins after initial surgery. Study was conducted on 50 patients of varicose veins with saphenofemoral junction incompetence. Patients were randomly divided into two groups, group A and group B alternately. In group A, standard surgical procedure was done followed by PTFE patch application. In group B, same surgical procedure was applied as in group A, with the exception of PTFE patch application. Patients in both groups were given similar postoperative care. A full venous duplex ultrasound assessment was performed in all the patients postoperatively. Neovascularization was observed in five patients (20 %) of group B, while it was not seen in any of the patients in group A at 1-year follow-up. This difference in neovascularization across the two groups was found to be statistically significant with a p value of 0.0251. Hence, authors concluded that patch saphenoplasty helps in reducing recurrence in varicose veins by decreasing neovascularization at saphenofemoral junction.

show abstract

Recurrent varicose veins: A national problem

Cited by 88 publications

References 7 publications

Pathogenesis of primary varicose veins

Pathogenesis of primary varicose veins

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

Role of PTFE Patch Saphenoplasty in Reducing Neovascularization and Recurrence in Varicose Veins

Contact Info

Product

Resources

About