Varicose Veins
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 significan
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Introduction to Varicose Veins 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,
R. Mandavia • M.A. Anwar • A.H. Davies (*) Academic Section of Vascular Surgery, Imperial College London, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK e-mail: [email protected]; [email protected]; [email protected]
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. The treatment of varicose veins accounts for approximately 2 % of the National Health Service (NHS) budget [1], while the population-based costs for treatment of chronic venous insufficiency (in the United States) have been estimated at $3 billion per year [5, 6], underlining their significant socioeconomic burden.
Pathophysiology of Varicose Veins and Metabolic Alterations The pathogenesis of varicose vein formation is complex and likely multifactorial. Hemodynamic disturbances play a significant role in its development. Venous valve failure has been considered a primary cause in disease development and can result in blood stasis and venous hypertension. Hemodynamic disturbances generating mechanical stretch and hypoxia of the vein wall subsequently induce venous wall remodeling, which is characterized by pathological changes in all three wall layers (see chapter “Overview” under part “Blood vessels”) [7].
E. Lammert, M. Zeeb (eds.), Metabolism of Human Diseases, DOI 10.1007/978-3-7091-0715-7_40, © Springer-Verlag Wien 2014
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274 Fig. 1 Possible relation of genetic and environmental factors and molecular changes in varicose veins development. HIF hypoxia-inducible factor, MMPs matrix metalloproteinas
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