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Joseph Shalhoub - One of the best experts on this subject based on the ideXlab platform.
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pathogenesis and etiology of recurrent Varicose Veins
Journal of Vascular Surgery, 2013Co-Authors: Maresa Brake, Chung S Lim, Amanda C Shepherd, Joseph ShalhoubAbstract:Background Recurrent Varicose Veins (RVV) occur in 13% to 65% of patients following treatment, and remain a debilitating and costly problem. RVV were initially thought largely to be due to inadequate intervention, however, more recently neovascularization and other factors have been implicated. This review aims to provide an overview of the current understanding of the etiology and pathogenesis of RVV. Methods A systematic search of the PubMed database was performed using the search terms including "recurrent," "Varicose Veins," and "neovascularization." Results Three types of RVV have been reported, namely residual Veins, true RVV, and new Varicose Veins, although the definitions varied between studies. RVV are attributable to causes including inadequate treatment, disease progression, and neovascularization. Using duplex ultrasonography, neovascularization has been observed in 25% to 94% of RVV. These new vessels appear in various size, number, and tortuosity, and they reconnect previously treated diseased Veins to the lower limb venous circulation. Histologically, these vessels appear primitive with incomplete vein wall formation, decreased elastic component, and lack of valves and accompanying nerves. Although the rate of RVV following open surgery and endovenous treatment appears similar, neovascularization seems less common following endothermal ablation. Other causes of RVV following endovenous treatment include recanalization and opening of collaterals. Conclusions Recurrence remains poorly understood following treatment of Varicose Veins. Neovascularization is an established and common cause of RVV, although other factors may contribute.
Mitchel P Goldman - One of the best experts on this subject based on the ideXlab platform.
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microfoam ultrasound guided sclerotherapy of Varicose Veins in 100 legs
Dermatologic Surgery, 2004Co-Authors: John M Barrett, Bruce Allen, Anne Ockelford, Mitchel P GoldmanAbstract:Objective. To demonstrate the efficacy of duplex-guided foam sclerotherapy measured against patient symptom relief and quality of life. Methods. An analysis was performed of 100 randomly chosen legs with Varicose Veins treated with ultrasound-guided foam sclerotherapy with a mean follow-up of 22.5 months. Results. An average number of 2.1 treatments using an average of 8.7 mL of foam sclerosing solution were required to close incompetent Varicose Veins. Thirty-one percent of leg Varicose Veins required a second treatment at 3 months; 100% of patients felt that their legs were successfully treated with resolution of all symptoms in 85% and resolution in all Varicose Veins in 92%. Conclusion. Ultrasound-guided foam sclerotherapy is effective in treating Varicose Veins with high patient satisfaction with results and improvement in quality of life.
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diagnosis and treatment of Varicose Veins a review
Journal of The American Academy of Dermatology, 1994Co-Authors: Mitchel P Goldman, R A Weiss, J J BerganAbstract:Varicose Veins are superficial vessels that are abnormally twisted, lengthened, or dilated and are usually caused by inefficient or defective valves within the vein. They represent a medical condition accompanied by symptoms deserving treatment. Varicose Veins are a manifestation of venous disease that may precede later severe complications. Varicosities cause cutaneous disease in addition to complications specific to the venous system. This article reviews the epidemiology, adverse sequelae, anatomy, pathophysiology, evaluation, and treatment of Varicose Veins. Learning objective: At the conclusion of this learning activity, participants should be able to discuss the role of varicosities in cutaneous disease, including aspects of epidemiology, anatomy, adverse sequelae, pathophysiology, diagnosis, and treatment.
Eric Ducasse - One of the best experts on this subject based on the ideXlab platform.
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association of primary Varicose Veins with dysregulated vein wall apoptosis
European Journal of Vascular and Endovascular Surgery, 2008Co-Authors: Eric Ducasse, Konstantinos Giannakakis, Francesco Speziale, Dominique Midy, E Sbarigia, Jeanclaude Baste, Tullio FaraggianaAbstract:Background. Disordered programmed cell death may play a role in the development of superficial venous incompetence. We have determined the number of cells in apoptosis, and the mediators regulating the intrinsic and extrinsic pathways in specimens of Varicose vein. Methods. Venous segments were obtained from 46 patients undergoing surgical treatment for primary Varicose Veins. Controls samples were obtained from 20 patients undergoing distal arterial bypass grafting surgery. Segments of the distal and proximal saphenous trunk as well as tributaries were studied. Cell apoptoses and mediators of the mitochondrial and trans membrane pathway were evaluated with peroxidase in situ apoptosis detection, Bax and Fas detection, caspase-9 and 8 detection in the medial layer. Results. Disorganised histological architecture was observed in Varicose Veins. Primary Varicose Veins also contained fewer peroxidase in situ-positive cells than control Veins (2.6% S.D. 0.2% versus 12% S.D. 0.93%, P ¼.0001, Mann-Whitney u test), fewer Bax positive cells (2.1.% S.D. 0.3% versus 13% S.D. 0.9%, P ¼.0001) and fewer Caspase 9 positive cells (3.2% S.D. 1% versus 12% S.D. 1.3%, P ¼.0001). Similar findings were observed in saphenous trunk, main tributaries and accessory Veins. In patients with recurrent Varicose Veins in whom the saphenous trunk had been preserved showed similar findings to primary Varicose Veins. Residual Varicose Veins contained fewer peroxidase in situ-positive cells than healthy Veins (3.2% S.D. 0.6% versus 11% S.D. 2%, P ¼.0001), fewer Bax positive cells (2.2% S.D. 0.3% versus 12% S.D. 0.7%, P ¼.0001) and fewer Caspase 9 positive cells (2.6% S.D. 0.6% versus 12% S.D. 1%, P ¼.0001). Immunohistochemical detection for Fas and caspase 8 remained equal was the same in the Varicose vein and control groups. Conclusion. Apoptosis is down regulated in the medial layer of Varicose Veins. This dysregulation is attributable to a disorder of the intrinsic pathway and involves the great saphenous vein trunk, major tributaries and accessory Veins. This process may be among the causes of primary Varicose Veins. 2007 Published by Elsevier Ltd on behalf of European Society for Vascular Surgery.
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Dysregulated apoptosis in primary Varicose Veins
European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery, 2005Co-Authors: Eric Ducasse, Konstantinos Giannakakis, J. Chevalier, D. Dasnoy, P. Puppinck, Francesco Speziale, Paolo Fiorani, Tullio FaraggianaAbstract:Abstract Objective Programmed cell death plays a critical role in various physiological processes. To investigate its possible pathogenic role in primary Varicose Veins we studied histological changes in surgical specimens from human Varicose Veins. In Varicose and healthy Veins, we also determined the number of cells in apoptosis, and investigated mediators regulating the intrinsic apoptotic mitochondrial pathway (Bax and caspase 9). Methods A total 23 Varicose Veins were obtained from 18 patients undergoing lower-extremity Varicose vein surgery for primary Varicose disorders. We used nine healthy Veins obtained from nine patients undergoing distal arterial bypass grafting surgery as controls. The venous segment analysed was the distal part of the greater saphenous vein. Specimens for histological examination were stained with hematoxylin and eosin, trichromic and Victoria blue. Cell apoptoses and mediators of the mitochondrial pathway were detected in the media by immunohistochemistry using antibodies to peroxidase in situ apoptosis, Bax and caspase 9. Results were expressed as indexes for the three antibodies tested. The Mann–Whitney test was used to compare the results obtained in the two groups. Results Varicose vein specimens exhibited a more disorganised architecture than healthy Veins and showed an increased number of collagen fibres and a decrease in the density and size of elastic fibres. All anti-apoptotic antibodies tested detected significantly fewer immunoreactive cells in tissue sections from the media of Varicose Veins than of healthy Veins (peroxidase in situ, Varicose Veins (VV) median 2.4% (inter-quartile range 1.6–3.9) versus control (C) 14% (IQR 8.8–19); Bax, VV 1.4% (IQR 0.36–2.4) versus C 11% (IQR 7.6–15); and caspase 9, VV 1.7% (IQR 0.06–3.4) versus C 10% (IQR 9.1–12), P=0.0001 (Mann–Whitney test). Conclusion Apoptosis is down regulated in the medial layer of Varicose Veins. This dysregulation of the cellular mechanism that maintains normal tissue integrity is mediated through the intrinsic apoptotic pathway and may be among the causes of primary Varicose Veins.
Maresa Brake - One of the best experts on this subject based on the ideXlab platform.
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pathogenesis and etiology of recurrent Varicose Veins
Journal of Vascular Surgery, 2013Co-Authors: Maresa Brake, Chung S Lim, Amanda C Shepherd, Joseph ShalhoubAbstract:Background Recurrent Varicose Veins (RVV) occur in 13% to 65% of patients following treatment, and remain a debilitating and costly problem. RVV were initially thought largely to be due to inadequate intervention, however, more recently neovascularization and other factors have been implicated. This review aims to provide an overview of the current understanding of the etiology and pathogenesis of RVV. Methods A systematic search of the PubMed database was performed using the search terms including "recurrent," "Varicose Veins," and "neovascularization." Results Three types of RVV have been reported, namely residual Veins, true RVV, and new Varicose Veins, although the definitions varied between studies. RVV are attributable to causes including inadequate treatment, disease progression, and neovascularization. Using duplex ultrasonography, neovascularization has been observed in 25% to 94% of RVV. These new vessels appear in various size, number, and tortuosity, and they reconnect previously treated diseased Veins to the lower limb venous circulation. Histologically, these vessels appear primitive with incomplete vein wall formation, decreased elastic component, and lack of valves and accompanying nerves. Although the rate of RVV following open surgery and endovenous treatment appears similar, neovascularization seems less common following endothermal ablation. Other causes of RVV following endovenous treatment include recanalization and opening of collaterals. Conclusions Recurrence remains poorly understood following treatment of Varicose Veins. Neovascularization is an established and common cause of RVV, although other factors may contribute.
Chieh-min Fan - One of the best experts on this subject based on the ideXlab platform.
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Epidemiology and pathophysiology of Varicose Veins.
Techniques in vascular and interventional radiology, 2003Co-Authors: Chieh-min FanAbstract:Varicose Veins and venous insufficiency of the lower extremities are among the most common disease entities affecting the general adult population. Venous insufficiency is estimated to be the seventh most common reason for medical referral in the United States.1 Although numerous epidemiological studies of venous insufficiency have been conducted internationally, the exact prevalence of Varicose Veins remains difficult to determine because of variability in study population selection criteria, survey methods, and disease definition between different studies. This point is illustrated by Table 1, which compares the study population age, methodology, and disease definition used in 5 major general population surveys for Varicose Veins.2 These studies show a relatively consistent prevalence of Varicose Veins in women (25-32%), compared with a wide variability in men (7-40%). Callam concluded from an analysis of 21 epidemiological studies of Varicose Veins1 that the overall prevalence of visible tortuous Varicose Veins in a Western population greater than 15 years of age was 10% to 15% for men and 20% to 25% for women. Table 2 summarizes the prevalence of Varicose Veins as determined in different nations over a 28-year period.2
