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Endovascular laser–tissue interactions and biological responses in relation to endovenous laser therapy

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Abstract

Endovenous laser treatment (ELT) has evolved into a frequently employed modality for the treatment of leg varicose veins. Due to the very high complete response rates, minimal complications and side effects, and the possibility to monitor therapeutic outcome noninvasively by duplex ultrasound, a considerable amount of reports have been published on clinical and translational studies, whereas disproportionally few studies have been performed to elucidate the molecular and cellular basis for post-ELT vessel obliteration. Consequently, this review addresses the putative molecular and cellular mechanisms responsible for varicose vein obliteration following laser irradiation in the context of endovenous laser–tissue interactions. First, the histological profile of laser-treated varicose veins is summarized, and an account is given of the temporal and spatial dynamics of cells involved in inflammation and remodeling in the heat-affected vein segment. Inasmuch as thrombotic occlusion of the venous lumen blocks circulatory access to the affected vessel segment and thermal damage in the vascular wall causes most cells to die, the majority of cells involved in inflammation and remodeling have to be recruited. Second, the (possible) biochemical triggers for the chemotactic attraction of immune cells and fibroblasts are identified, comprising (1) thermal coagula, (2) thrombi, (3) dead and dying cells in the vein wall, and (4) thermally denatured extracellular matrix proteins in the vein wall. The molecular biology underlying the chemotactic signaling and subsequent obliterative remodeling is elucidated. Finally, the relative contribution of every biochemical trigger to obliterative remodeling is addressed.

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Abbreviations

ATP:

Adenosine triphosphate

CCL:

CC chemokine ligand

CXCL:

Chemokine (C–X–C motif) ligand

DAMP:

Damage-associated molecular pattern

DNA:

Deoxyribonucleic acid

EC:

Endothelial cell

ECM:

Extracellular matrix

ELT:

Endovenous laser ablation

ERK:

Extracellular-signal-regulated kinase

FGF:

Fibroblast growth factor

HMGB-1:

High-mobility group box 1

HSP:

Heat shock protein

ICAM:

Intercellular adhesion molecule

IL:

Interleukin

JNK:

c-Jun N-terminal kinase

MCP:

Monocyte chemotactic protein

MIP:

Macrophage inflammatory protein

MMP:

Matrix metalloproteinase

MSR:

Macrophage scavenging receptor

PDGF:

Platelet-derived growth factor

PSGL:

P-selectin glycoprotein ligand

RAGE:

Receptor for advanced glycation end products

RNA:

Ribonucleic acid

SMC:

Smooth muscle cell

SRC:

The human orthologue of the Src (gene), encoding v-src sarcoma (Schmidt-Ruppin A-2) viral oncogene homolog

TGF:

Transforming growth factor

TIMP:

Tissue inhibitor of metalloproteinases

TLR:

Toll-like receptor

TNF:

Tumor necrosis factor

uPA:

Urokinase-type plasminogen activator

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Acknowledgements

MH is sponsored by grants from the Dutch Anti-Cancer Foundation in Amsterdam (Stichting Nationaal Fonds Tegen Kanker), the Phospholipid Research Center in Heidelberg, the Nijbakker-Morra Foundation in Leiden, and the Stichting Technologische Wetenschap. RFvG is sponsored by an AMC Scholarship grant.

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  1. Department of Experimental Surgery, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands

    Michal Heger, Rowan F. van Golen, Mans Broekgaarden & Thomas M. van Gulik

  2. Department of Dermatology, Erasmus MC, Rotterdam, The Netherlands

    Renate R. van den Bos & H. A. Martino Neumann

  3. Biomedical Engineering and Physics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

    Martin J. C. van Gemert

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  1. Michal Heger
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Correspondence to Michal Heger.

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R. F. van Golen and M. Broekgaarden contributed equally to the paper

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Heger, M., van Golen, R.F., Broekgaarden, M. et al. Endovascular laser–tissue interactions and biological responses in relation to endovenous laser therapy. Lasers Med Sci 29, 405–422 (2014). https://doi.org/10.1007/s10103-013-1490-3

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