Advertisement

Varicose Veins

  • Rishi Mandavia
  • Muzaffar A. Anwar
  • Alun H. DaviesEmail author
Chapter

Abstract

Varicose veins are characterized by tortuous and dilated veins that are incompetent in terms of their ability to pump venous blood in sufficient amounts back to the heart. The disease mainly affects the lower limbs [1]. Varicose veins can cause significant morbidity and negatively impact quality of life [2]. Symptoms include pain, heaviness, aching, swelling, restless legs, cramps, and itching. Complications of varicose veins include bleeding and skin changes including lipodermatosclerosis (an inflammation of the fat layer below the epidermis) and ulceration [1]. The etiology of varicose veins is unclear. Our current understanding is that varicose veins are a manifestation of chronic venous insufficiency (CVI), whereby return of venous blood is impaired owing to calf muscle pump failure (i.e., the ability to press venous blood toward the heart via calf muscle contractions), venous obstruction, or reflux. This causes an increase in venous blood pressure resulting in swelling of the leg and the cutaneous manifestations characteristic of this condition [3]. Risk factors for varicose veins include female sex, obesity, pregnancy, positive family history, prolonged standing, and a past history of deep vein thrombosis. The reported incidence of varicose veins is variable, ranging from 2 to 56 % in men and 1 to 73 % in women [4]. Diagnosis is clinical, reliant on clinical history and examination. The gold standard imaging technique is color duplex ultrasound enabling assessment of the deep and superficial venous systems.

Keywords

Varicose Vein Vein Wall Chronic Venous Insufficiency Chronic Venous Insufficiency Calcium Dobesilate 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Lim CS, Davies AH (2009) Pathogenesis of primary varicose veins. Br J Surg 96:1231–1242CrossRefPubMedGoogle Scholar
  2. 2.
    Darvall KA, Bate GR, Adam DJ, Bradbury AW (2012) Generic health-related quality of life is significantly worse in varicose vein patients with lower limb symptoms independent of CEAP clinical grade. Eur J Vasc Endovasc Surg 44:341–344CrossRefPubMedGoogle Scholar
  3. 3.
    Raffetto JD, Khalil RA (2008) Mechanisms of varicose vein formation: valve dysfunction and wall dilation. Phlebology 23:85–98CrossRefPubMedGoogle Scholar
  4. 4.
    Scott TE, LaMorte WW, Gorin DR, Menzoian JO (1995) Risk factors for chronic venous insufficiency: a dual case-control study. J Vasc Surg 22:622–628CrossRefPubMedGoogle Scholar
  5. 5.
    Meissner MH, Gloviczki P, Bergan J, Kistner RL, Morrison N, Pannier F, Pappas PJ, Rabe E, Raju S, Villavicencio JL (2007) Primary chronic venous disorders. J Vasc Surg 46:54S–67SCrossRefPubMedGoogle Scholar
  6. 6.
    Brake M, Lim CS, Shepherd AC, Shalhoub J, Davies AH (2013) Pathogenesis and etiology of recurrent varicose veins. J Vasc Surg 57:860–868CrossRefPubMedGoogle Scholar
  7. 7.
    Anwar MA, Shalhoub J, Lim CS, Gohel MS, Davies AH (2012) The effect of pressure-induced mechanical stretch on vascular wall differential gene expression. J Vasc Res 49:463–478CrossRefPubMedGoogle Scholar
  8. 8.
    Somers P, Knaapen M (2006) The histopathology of varicose vein disease. Angiology 57:546–555CrossRefPubMedGoogle Scholar
  9. 9.
    Kakkos SK, Zolota VG, Peristeropoulou P, Apostolopoulou A, Geroukalos G, Tsolakis IA (2003) Increased mast cell infiltration in familial varicose veins: pathogenetic implications? Int Angiol 22:43–49PubMedGoogle Scholar
  10. 10.
    Yamada T, Tomita S, Mori M, Sasatomi E, Suenaga E, Itoh T (1996) Increased mast cell infiltration in varicose veins of the lower limbs: a possible role in the development of varices. Surgery 119:494–497CrossRefPubMedGoogle Scholar
  11. 11.
    Jacob T, Hingorani A, Ascher E (2005) Overexpression of transforming growth factor-beta1 correlates with increased synthesis of nitric oxide synthase in varicose veins. J Vasc Surg 41:523–530CrossRefPubMedGoogle Scholar
  12. 12.
    Cario-Toumaniantz C, Boularan C, Schurgers LJ, Heymann MF, Le Cunff M, Léger J, Loirand G, Pacaud P (2007) Identification of differentially expressed genes in human varicose veins: involvement of matrix gla protein in extracellular matrix remodeling. J Vasc Res 44:444–459CrossRefPubMedGoogle Scholar
  13. 13.
    Wali MA, Eid RA (2001) Smooth muscle changes in varicose veins: an ultrastructural study. J Smooth Muscle Res 37:123–135CrossRefPubMedGoogle Scholar
  14. 14.
    Ascher E, Jacob T, Hingorani A, Tsemekhin B, Gunduz Y (2001) Expression of molecular mediators of apoptosis and their role in the pathogenesis of lower-extremity varicose veins. J Vasc Surg 33:1080–1086CrossRefPubMedGoogle Scholar
  15. 15.
    Lim CS, Gohel MS, Shepherd AC, Paleolog E, Davies AH (2010) Venous hypoxia: a poorly studied etiological factor of varicose veins. J Vasc Res 48:185–194CrossRefPubMedGoogle Scholar
  16. 16.
    Lim CS, Kiriakidis S, Paleolog EM, Davies AH (2012) Increased activation of the hypoxia-inducible factor pathway in varicose veins. J Vasc Surg 55:1427–1439CrossRefPubMedGoogle Scholar
  17. 17.
    Gandhi RH, Irizarry E, Nackman GB, Halpern VJ, Mulcare RJ, Tilson MD (1993) Analysis of the connective tissue matrix and proteolytic activity of primary varicose veins. J Vasc Surg 18:814–820CrossRefPubMedGoogle Scholar
  18. 18.
    Lim CS, Shalhoub J, Gohel MS, Shepherd AC, Davies AH (2010) Matrix metalloproteinases in vascular disease – a potential therapeutic target? Curr Vasc Pharmacol 8:75–85CrossRefPubMedGoogle Scholar
  19. 19.
    Jacob MP, Cazaubon M, Scemama A, Prié D, Blanchet F, Guillin MC, Michel JB (2002) Plasma matrix metalloproteinase-9 as a marker of blood stasis in varicose veins. Circulation 106:535–538CrossRefPubMedGoogle Scholar
  20. 20.
    Tanaka H, Zaima N, Sasaki T, Yamamoto N, Sano M, Konno H, Setou M, Unno N (2012) Loss of lymphatic vessels and regional lipid accumulation is associated with great saphenous vein incompetence. J Vasc Surg 55:1440–1448CrossRefPubMedGoogle Scholar
  21. 21.
    Anwar MA, Shalhoub J, Vorkas PA, Lim CS, Want EJ, Nicholson JK, Holmes E, Davies AH (2012) In-vitro identification of distinctive metabolic signatures of intact varicose vein tissue via magic angle spinning nuclear magnetic resonance spectroscopy. Eur J Vasc Endovasc Surg 44:442–450CrossRefPubMedGoogle Scholar
  22. 22.
    Hamdan A (2012) Management of varicose veins and venous insufficiency. JAMA 308:2612–2621CrossRefPubMedGoogle Scholar
  23. 23.
    Rasmussen LH, Lawaetz M, Bjoern L, Vennits B, Blemings A, Eklof B (2011) Randomized clinical trial comparing endovenous laser ablation, radiofrequency ablation, foam sclerotherapy and surgical stripping for great saphenous varicose veins. Br J Surg 98:1079–1087CrossRefPubMedGoogle Scholar
  24. 24.
    Tsang FJ, Davis M, Davies AM, Davies AH (2005) Incomplete saphenopopliteal ligation after short saphenous vein surgery: a summation analysis. Phlebology 20:106–109CrossRefGoogle Scholar
  25. 25.
    Smith PD (2000) Micronized purified flavonoid fraction and the treatment of chronic venous insufficiency: microcirculatory mechanisms. Microcirculation 7:35–40CrossRefGoogle Scholar
  26. 26.
    Gohel MS, Davies AH (2010) Pharmacological treatment in patients with C4, C5 and C6 venous disease. Phlebology 25:35–41CrossRefPubMedGoogle Scholar
  27. 27.
    Pittler MH, Ernst E (2012) Horse chestnut seed extract for chronic venous insufficiency. Cochrane Database Syst Rev (11):CD003230Google Scholar
  28. 28.
    Canali R, Comitato R, Schonlau F, Virgili F (2009) The anti-inflammatory pharmacology of Pycnogenol ((R)) in humans involves COX-2 and 5-LOX mRNA expression in leukocytes. Int Immunopharmacol 9:1145–1149CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Wien 2014

Authors and Affiliations

  • Rishi Mandavia
    • 1
  • Muzaffar A. Anwar
    • 1
  • Alun H. Davies
    • 1
    Email author
  1. 1.Academic Section of Vascular SurgeryImperial College London, Charing Cross HospitalLondonUK

Personalised recommendations