Varicose veins are a risk factor for deep venous thrombosis in general practice patients

Müller-Bühl, U; Leutgeb, Rüdiger; Engeser, Peter; Achankeng, Edwane N; Szécsényi, Joachim; Laux, Gunter

doi:10.1024/0301-1526/a000222

Cited by 70 publications

(55 citation statements)

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“…It is questionable, if many of DVTs occurring after 30 days can be directly attributed to the patients' VV treatment; more likely this represents an inherent predisposition of varicose veins to DVT formation. This would be consistent with the fi nding that primary care patients with VV have an increased risk of DVT compared to patients without VV [15], and that treating some or all of the varicosities does not seem to eliminate this risk. Understanding this phenomenon in its entirety requires knowledge of the incidence of the DVT in patients with varicose veins who are managed conservatively, which at present does not exist.…”

Section: Number Of Vtes By Yearsupporting

confidence: 77%

Risk of venous thromboembolism following surgical treatment of superficial venous incompetence

Barker

Evison

Benson

et al. 2017

Vasa

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Summary:Background: The invasive management of varicose veins has a known risk of post-operative deep venous thrombosis and subsequent pulmonary embolism. The aim of this study was to evaluate absolute and relative risk of venous thromboembolism (VTE) following commonly used varicose vein procedures. Patients and methods: A retrospective analysis of secondary data using Hospital Episode Statistics database was performed for all varicose vein procedures performed between 2003 and 2013 and all readmissions for VTE in the same patients within 30 days, 90 days, and one year. Comparison of the incidence of VTEs between procedures was performed using a Pearson's Chi-squared test. Results: In total, 261,169 varicose vein procedures were performed during the period studied. There were 686 VTEs recorded at 30 days (0.26 % incidence), 884 at 90 days (0.34 % incidence), and 1,246 at one year (0.48 % incidence). The VTE incidence for different procedures was between 0.15-0.35 % at 30 days, 0.26-0.50 % at 90 days, and 0.46-0.58 % at one year. At 30 days there was a signifi cantly lower incidence of VTEs for foam sclerotherapy compared to other procedures (p = 0.01). There was no difference in VTE incidence between procedures at 90 days (p = 0.13) or one year (p = 0.16). Conclusions: Patients undergoing varicose vein procedures have a small but appreciable increased risk of VTE compared to the general population, with the effect persisting at one year. Foam sclerotherapy had a lower incidence of VTE compared to other procedures at 30 days, but this effect did not persist at 90 days or at one year. There was no other signifi cant difference in the incidence of VTE between open, endovenous, and foam sclerotherapy treatments. Keywords: Varicose veins, vascular surgical procedures, thrombosis, embolusThe wide range of reported incidences may be accounted for by the varying length of follow-ups in the studies and by whether routine duplex scanning was performed postoperatively or it was relied upon the development of clinical features of a DVT. The signifi cance of duplex identifi ed DVTs in the absence of clinical signs is uncertain; however, one series examining this problem reported no instances of a patients with early positive duplex fi ndings developing a clinical DVT on long term follow-up [3].The relative risk of DVT following diff erent VV procedures is currently unknown. NICE guidelines have highlighted the lack of large cohorts and high quality evidence, investigating this phenomenon, as the available evidence is limited to comparisons between two procedure types, with relatively small cohorts leading to identifi cation of sporadic events, which preclude in-depth statistical analysis. Currently the only reported comparisons are the ones between RFA and EVLA, which demonstrate no signifi cant diff erence in the incidence of DVT between these two procedures [5,10].

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Section: Number Of Vtes By Yearsupporting

confidence: 77%

Risk of venous thromboembolism following surgical treatment of superficial venous incompetence

Barker

Evison

Benson

et al. 2017

Vasa

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“…Conversely, VVs may develop as a part of post‐thrombotic syndrome following DVT. Müller‐Bühl et al analyzed ICD coding‐based primary care register data and demonstrated that DVT was nearly six times more frequent among VVs patients than among individuals without VVs . Based on this evidence, we cannot exclude the possibility of some bias in “23andMe” and the UK Biobank studies.…”

Section: Discussionmentioning

confidence: 94%

Polymorphisms of genes involved in inflammation and blood vessel development influence the risk of varicose veins

et al. 2018

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Heredity plays an important role in the etiology of varicose veins (VVs). However, the genetic basis underlying this condition remains poorly understood. Our aim was to replicate top association signals from genome-wide association studies (GWASs) for VVs of lower extremities using 2 independent datasets-our sample of ethnic Russian individuals (709 cases and 278 controls) and a large cohort of British residents from UK Biobank (10 861 cases and 397 594 controls). Associations of polymorphisms rs11121615, rs6712038, rs507666, rs966562, rs7111987, rs6062618, and rs6905288 were validated in the UK Biobank individuals at a Bonferroni-corrected significance level. In Russian cohort, only rs11121615 reached a nominal significance level of P < .05. Results of original GWAS and replication studies were combined by a meta-analysis, and polymorphisms listed above as well as rs111434909 and rs4463578 passed a genome-wide significant threshold. Notably, the majority of these polymorphisms were located within or near genes involved in vascular development and remodeling, and regulation of inflammatory response. Our results confirm the role of these polymorphisms in genetic susceptibility to VVs and indicate the revealed genomic regions as good candidates for further fine-mapping studies and functional analysis. Moreover, our findings implicate inflammation and abnormal vascular architecture in VVs pathogenesis.

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“…Varicose veins, caused by reduced venous blood flow, affect a different part of the venous system but represent a DVT-associated disease, that, at least in its severe form, presents a risk factor for DVT. 31 Similar to thrombotic deep veins, human varicose veins often contain a greater number of inflammatory cells, including T cells. 32 To examine the impact of blood flow reduction on T-cell recruitment in the human venous system, we analyzed the composition of the T cell infiltrate in varicose veins compared with peripheral blood.…”

Section: Human Varicose Veins Predominantly Contain T Em Cellsmentioning

confidence: 99%

Innate Effector-Memory T-Cell Activation Regulates Post-Thrombotic Vein Wall Inflammation and Thrombus Resolution

Luther

Shahneh

Brähler

et al. 2016

Circulation Research

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Deep vein thrombosis (DVT) is the most common type of venous thromboembolism. Patients with DVT are at risk of developing potentially life-threatening complications, such as pulmonary embolism, but also long-term complications, including post-thrombotic syndrome and chronic thromboembolic pulmonary hypertension.1 Current treatments for DVT focus on preventing clot expansion with anticoagulants and vasoactive drugs and by increasing venous blood flow through physical methods. However, anticoagulation cannot accelerate the natural thrombus resolution and reciprocally increases the risk of bleeding. Despite initial management of symptomatic acute events, patients remain at high risk for recurrence and predisposed to developing long-term complications. Transition of thromboembolic events to chronic disease is essentially caused by persistent inflammation resulting in delayed thrombus resolution, fibrosis, and vessel wall damage. Conclusions: T EM orchestrate the inflammatory response in venous thrombosis affecting thrombus resolution.

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Varicose veins are a risk factor for deep venous thrombosis in general practice patients

Cited by 70 publications

References 0 publications

Risk of venous thromboembolism following surgical treatment of superficial venous incompetence

Risk of venous thromboembolism following surgical treatment of superficial venous incompetence

Polymorphisms of genes involved in inflammation and blood vessel development influence the risk of varicose veins

Innate Effector-Memory T-Cell Activation Regulates Post-Thrombotic Vein Wall Inflammation and Thrombus Resolution

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