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Acta Dermato-venereologica May 2024Martorell hypertensive ischaemic leg ulcer (Martorell HYTILU) is a rare but significant cause of distal leg ulcers. Although hypertension and diabetes are known factors... (Comparative Study)
Comparative Study
Martorell hypertensive ischaemic leg ulcer (Martorell HYTILU) is a rare but significant cause of distal leg ulcers. Although hypertension and diabetes are known factors in its development, the precise pathogenesis of Martorell HYTILU remains elusive. To reach a better understanding of Martorell HYTILU, transcriptomic analysis was conducted through RNA sequencing and immunohistochemical comparison of Martorell HYTILU (n = 17) with chronic venous ulcers (n = 4) and healthy skin (n = 4). Gene expression analysis showed a marked activation of immune-related pathways in both Martorell HYTILU and chronic venous ulcers compared with healthy skin. Notably, neutrophil activity was substantially higher in Martorell HYTILU. While pathway analysis revealed a mild downregulation of several immune pathways in Martorell HYTILU compared with chronic venous ulcers, keratinization, cornification, and epidermis development were significantly upregulated in Martorell HYTILU. Additionally, STAC2, a gene encoding for a protein promoting the expression of the calcium channel Cav1.1, was significantly upregulated in Martorell HYTILU and was detected perivascularly in situ (Martorell HYTILU n = 24; chronic venous ulcers n = 9, healthy skin n = 11). The high expression of STAC2 in Martorell HYTILU suggests that increased calcium influx plays an important role in the pathogenesis of the disease. Consequently, calcium channel antagonists could be a promising treatment avenue for Martorell HYTILU.
Topics: Humans; Male; Female; Varicose Ulcer; Aged; Chronic Disease; Hypertension; Middle Aged; Skin; Ischemia; Gene Expression Profiling; Transcriptome; Case-Control Studies; Leg Ulcer; Aged, 80 and over
PubMed: 38813744
DOI: 10.2340/actadv.v104.40090 -
Endoscopy Dec 2024
Bleeding parastomal varices in a case of decompensated cirrhosis with tubercular abdominal cocoon: endoscopic ultrasound-guided angioembolization with coil and glue to the rescue.
Topics: Humans; Embolization, Therapeutic; Endosonography; Gastrointestinal Hemorrhage; Liver Cirrhosis; Male; Varicose Veins; Middle Aged; Ultrasonography, Interventional; Esophageal and Gastric Varices
PubMed: 38810976
DOI: 10.1055/a-2316-0994 -
Annals of Vascular Surgery May 2024The primary aim of this study was to assess the feasibility of introducing a digital health education tool (dHET) for varicose vein surgery.
BACKGROUND
The primary aim of this study was to assess the feasibility of introducing a digital health education tool (dHET) for varicose vein surgery.
METHODS
This randomized, feasibility study allocated 40 patients, into dHET (n = 20) or standard consent (SC) (n = 20) groups. Primary outcomes were related to feasibility. Secondary outcomes were knowledge recall, anxiety, and satisfaction.
RESULTS
Recruitment and retention rates were 100% and 97.5%, respectively. Acceptability was also rated high, confirming feasibility. There was also no evidence of a difference between groups for early knowledge recall (14 [12-17] vs. 14 [11-16]; P = 0.72) or delayed (at 2 weeks) knowledge recall (15 [13-16] vs. 15 [13-16]; P = 0.89). The dHET module took significantly longer to complete compared to SC (13 min [12-18] vs. 9 min [8-12]; P < 0.01). However, the control group asked significantly more questions about the intended procedure (P = 0.03). There was no evidence of a difference between groups for patient anxiety or satisfaction.
CONCLUSIONS
This trial shows that the addition of a dHET is feasible and noninferior to SC. Digital consent provides a unique opportunity to promote patient education and autonomy for better shared decision making. It also offers better documentation of the consent process.
PubMed: 38810723
DOI: 10.1016/j.avsg.2024.02.030 -
Journal of Vascular Surgery. Venous and... May 2024This study aimed to evaluate whether differences exist in the quality of life changes and complication rates after treatment of incompetent saphenous vein (ISV) based on...
OBJECTIVE
This study aimed to evaluate whether differences exist in the quality of life changes and complication rates after treatment of incompetent saphenous vein (ISV) based on the presence of segmental popliteal vein reflux (SPVR).
METHODS
Patients who underwent treatment for ISV from July 2016 to July 2021 were included and divided into two groups: patients without deep venous reflux (DVR) and patients with SPVR. Patients with axial DVR, a history of deep vein thrombosis, a history of orthopedic surgery, previous venous treatment, and no postoperative follow-up were excluded from the study. Duplex ultrasound examination was performed preoperatively and at 6 and 12 months postoperatively.
RESULTS
The study included 233 patients (398 limbs), and 50 (64 limbs) had SPVR. Differences were not observed in gender, age, body mass index, distribution of clinical class according to Clinical-Etiology-Anatomy-Physiology classification, laterality, treatment method, and preoperative Venous Clinical Severity Score or Aberdeen Varicose Vein Questionnaire scores between the two groups with SPVR or without DVR. Furthermore, the Venous Clinical Severity Score and Aberdeen Varicose Vein Questionnaire scores at 6 and 12 months postoperatively were improved in both groups, although without significant differences. A significant difference was not observed in the rate of postoperative complications between the groups based on the presence of SPVR (1.8% vs 1.6%: P = .896). The SPVR improvement rate after ISV treatment was 25% (16/64), and patient-reported outcomes in patients combined with SPVR improved independent of treatment modality, saphenous vein treatment section, and postoperative SPVR improvement.
CONCLUSIONS
Complication rates and clinical outcomes after ISV treatment did not differ in the presence of SPVR. In patients with SPVR, after ISV treatment, quality of life improved regardless of treatment modality, saphenous vein treatment section, and postoperative SPVR improvement.
PubMed: 38810693
DOI: 10.1016/j.jvsv.2024.101918 -
MMW Fortschritte Der Medizin Jun 2024
Review
Topics: Varicose Veins; Humans; Diagnosis, Differential
PubMed: 38806903
DOI: 10.1007/s15006-024-3999-8 -
Journal of Ayurveda and Integrative... May 2024
PubMed: 38795578
DOI: 10.1016/j.jaim.2024.100931 -
Frontiers in Surgery 2024To compare the analgesic effects of specific tumescent anesthetic solutions composed of lidocaine, ropivacaine, or a combination of lidocaine and ropivacaine during...
OBJECTIVE
To compare the analgesic effects of specific tumescent anesthetic solutions composed of lidocaine, ropivacaine, or a combination of lidocaine and ropivacaine during endovenous radiofrequency ablation for the treatment of great saphenous vein varicosities.
METHOD
This study included 149 patients with lower limb varicose veins who were admitted to our department between 2019 and 2023. The patients were randomly assigned to three groups: the lidocaine group (Group I), the ropivacaine group (Group II), and the lidocaine + ropivacaine group (Group III). Intraoperative vital signs, intraoperative and postoperative visual analog scale (VAS) pain scores, and long-term treatment outcomes were assessed using the venous clinical severity score (VCSS) based on clinical performance.
RESULTS
There were no significant differences in age, body mass index, operative time, or blood loss among the three groups ( ≥ 0.05). The differences in the mean arterial pressure and heart rate during surgery in Group II were significantly greater than those in Groups I and III ( < 0.05). The intraoperative VAS scores in Group II were higher than those in Groups I and III ( < 0.05) and at 8 and 12 h postoperatively. There were no significant differences in VCSS among the groups ( ≥ 0.05).
CONCLUSION
The use of a tumescent anesthetic solution composed of lidocaine and ropivacaine significantly improved patient comfort during the perioperative period without affecting surgical outcomes. This formulation can be considered safe and reliable for preparing tumescent anesthesia solutions.
PubMed: 38783860
DOI: 10.3389/fsurg.2024.1359474 -
Phlebology Jun 2024Chronic venous disease (CVD) is an umbrella term for a group of morphological and functional disorders of the venous system. Clinical signs of CVD may range from... (Review)
Review
Chronic venous disease (CVD) is an umbrella term for a group of morphological and functional disorders of the venous system. Clinical signs of CVD may range from telangiectasia and reticular veins to active venous ulcers; therefore, earlier diagnosis and management of CVD may delay disease progression and reduce the burden of CVD on patients, caregivers, and healthcare systems. In this podcast discussion, Professor Andrew Nicolaides, Professor Stavros Kakkos, and Dr Gerardo Estrada-Guerrero share the key highlights from their symposium at the 2023 European Venous Forum. This symposium, titled "Chronic venous disease: what if everything started with early care?", discussed the clinical significance of "functional CVD," evidence and risk factors for CVD progression, and real-world strategies to facilitate earlier diagnosis and management of CVD. Together, these topics highlight the importance of early care to improve long-term outcomes for people with CVD.
PubMed: 38782035
DOI: 10.1177/02683555241230737 -
MedRxiv : the Preprint Server For... May 2024Central serous chorioretinopathy (CSC) is a fluid maculopathy whose etiology is not well understood. Abnormal choroidal veins in CSC patients have been shown to have...
Central serous chorioretinopathy (CSC) is a fluid maculopathy whose etiology is not well understood. Abnormal choroidal veins in CSC patients have been shown to have similarities with varicose veins. To identify potential mechanisms, we analyzed genotype data from 1,477 CSC patients and 455,449 controls in FinnGen. We identified an association for a low-frequency (AF=0.5%) missense variant (rs113791087) in the gene encoding vascular endothelial protein tyrosine phosphatase (VE-PTP) (OR=2.85, P=4.5×10). This was confirmed in a meta-analysis of 2,452 CSC patients and 865,767 controls from 4 studies (OR=3.06, P=7.4×10). Rs113791087 was associated with a 56% higher prevalence of retinal abnormalities (35.3% vs 22.6%, P=8.0×10) in 708 UK Biobank participants and, surprisingly, with varicose veins (OR=1.31, P=2.3×10) and glaucoma (OR=0.82, P=6.9×10). Predicted loss-of-function variants in VEPTP, though rare in number, were associated with CSC in All of Us (OR=17.10, P=0.018). These findings highlight the significance of VE-PTP in diverse ocular and systemic vascular diseases.
PubMed: 38766240
DOI: 10.1101/2024.05.08.24307013 -
European Journal of Cell Biology Jun 2024Varicose veins are the most common venous disorder in humans and are characterized by hemodynamic instability due to valvular insufficiency and orthostatic lifestyle...
Varicose veins are the most common venous disorder in humans and are characterized by hemodynamic instability due to valvular insufficiency and orthostatic lifestyle factors. It is unclear how changes in biomechanical signals cause aberrant remodeling of the vein wall. Our previous studies suggest that Notch signaling is implicated in varicose vein arterialization. In the arterial system, mechanoresponsive ETS1 is a transcriptional activator of the endothelial Notch, but its involvement in sensing disrupted venous flow and varicose vein formation has not been investigated. Here, we use human varicose veins and cultured human venous endothelial cells to show that disturbed venous shear stress activates ETS1-NOTCH4/DLL4 signaling. Notch components were highly expressed in the neointima, whereas ETS1 was upregulated in all histological layers of varicose veins. In vitro microfluidic flow-based studies demonstrate that even minute changes in venous flow patterns enhance ETS1-NOTCH4/DLL4 signaling. Uniform venous shear stress, albeit an inherently low-flow system, does not induce ETS1 and Notch proteins. ETS1 activation under altered flow was mediated primarily by MEK1/2 and, to a lesser extent, by MEK5 but was independent of p38 MAP kinase. Endothelial cell-specific ETS1 knockdown prevented disturbed flow-induced NOTCH4/DLL4 expression. TK216, an inhibitor of ETS-family, prevented the acquisition of arterial molecular identity and loss of endothelial integrity in cells exposed to the ensuing altered shear stress. We conclude that ETS1 senses blood flow disturbances and may promote venous remodeling by inducing endothelial dysfunction. Targeting ETS1 rather than downstream Notch proteins could be an effective and safe strategy to develop varicose vein therapies.
Topics: Humans; Signal Transduction; Proto-Oncogene Protein c-ets-1; Receptor, Notch4; Varicose Veins; Calcium-Binding Proteins; Adaptor Proteins, Signal Transducing; Endothelial Cells; Endothelium, Vascular; Male; Stress, Mechanical; Membrane Proteins; Female; Human Umbilical Vein Endothelial Cells
PubMed: 38759515
DOI: 10.1016/j.ejcb.2024.151420