Abstract
Objectives: Among all the manifestations of the circulatory system of return, it is perhaps the chronic venous insufficiency that originates the most demand for consultation. This venous pathology that at first may occur imperceptibly, achieves within its development to generate conditions at the structural level in the venous wall that directly activate a series of symptoms that partially or totally incapacitate the sufferer. This is why the main objective of this review is to identify the best existing evidence on chronic venous insufficiency and structural changes in the vein wall.
Method: bibliographical review, descriptive of longitudinal section and retrospective of the controlled scientific literature based on systematic reviews.
Results: The evidence obtained confirmed that people between 60 and 69 years of age are the most prevalent in the development of CVI, representing 47% of the population studied. Followed by those who range between 70/79 years of age for 26% of the total sample of patients. On the other hand, in terms of sex, the studies evaluated show a higher incidence of CVI in females, representing 65% of the population studied. Regarding the risk factors for the development of the IVC, the studies showed that the non-modifiable ones have the highest incidence. It was possible to see among the authors coincidence with regard to the clinical manifestations that in one way or another regardless of which gave rise to the emergence of CVI, are the symptomatological picture prevailing in this venous pathology. Regarding the structural changes in the walls of the veins as a consequence of the IVC, the authors suggest that these modifications are characterized by the thickening and deformation of the vessel, with an increase in its permeability and loss of its antithrombotic properties. They also describe that in the histological study, endothelial cells with different degrees of alteration are revealed. From the increase of its organelles with the presence of large vesicles and vacuoles, degenerative myeloid bodies and developed cytoskeleton, to cells that have completely or partially detached from the venous wall. The subendothelial region shows great collagen infiltration.
Conclusion: Among the risk factors predisposing to CVI, the studies reviewed include gender, age and family history. They also establish that the female sex is the most prone to the development of this venous pathology and people who are between 60 and 79 years of age. The most evident clinical symptomatology in the IVC is the sensation of heaviness, cramps, pruritus and evening edemas. With regard to the structural changes of the venous wall, the authors describe a thickening at the intimal level and in the middle layer, increase in collagen fibers, decrease in elastics and alteration of the morphology of smooth muscle cells that lose their characteristic orientation.
Keywords
References
2. Husfeldt K. Venous replacement with Gore-tex prosthesis: experimental and first clinical results. Pelvic and abdominal veins: Progress in diagnosis and therapy. Excerpta Medica; Amsterdam. 1981, 249-258.
3. Ijima H, Kodama M, Hori M. Temporary arteriovenous fistula for venous reconstruction using synthetic graft: a clinical and experimental investigation. The Journal of Cardiovascular Surgery. 1985;26(2):131-136.
4. Plate G, Einarsson E, Eklöf B, Jensen R, Ohlin P. Iliac vein obstruction associated with acute iliofemoral venous thrombosis. Results of early reconstruction using polytetrafluoroethylene grafts. Acta Chir Scand. 1985;151(7):607-611.
5. Okadome K. Venous Reconstruction for Iliofemoral Venous Occlusion Facilitated by Temporary Arteriovenous Shunt. Archives of Surgery. 1989 08 01;124(8):957. https://doi.org/10.1001/archsurg.1989.01410080093015
6. Gloviczki P, Pairolero PC, Toomey BJ, Bower TC, Rooke TW, Stanson AW, Hallett JW, Cherry KJ. Reconstruction of large veins for nonmalignant venous occlusive disease. Journal of Vascular Surgery. 1992 Nov;16(5):750-761. https://doi.org/10.1016/0741-5214(92)90230-6
7. Alimi Y, DiMauro P, Fabre D, Juhan C. Iliac vein reconstructions to treat acute and chronic venous occlusive disease. Journal of Vascular Surgery. 1997 04;25(4):673-681. https://doi.org/10.1016/s0741-5214(97)70294-5
8. Jost CJ, Gloviczki P, Cherry KJ, McKusick MA, Harmsen WS, Jenkins GD, Bower TC. Surgical reconstruction of iliofemoral veins and the inferior vena cava for nonmalignant occlusive disease. Journal of Vascular Surgery. 2001 02;33(2):320-328. https://doi.org/10.1067/mva.2001.112805
9. Neglén P, Hollis KC, Olivier J, Raju S. Stenting of the venous outflow in chronic venous disease: Long-term stent-related outcome, clinical, and hemodynamic result. Journal of Vascular Surgery. 2007 Nov;46(5):979-990.e1. https://doi.org/10.1016/j.jvs.2007.06.046
10. Hartung O, Loundou A, Barthelemy P, Arnoux D, Boufi M, Alimi Y. Endovascular Management of Chronic Disabling Ilio-caval Obstructive Lesions: Long-Term Results. European Journal of Vascular and Endovascular Surgery. 2009 07;38(1):118-124. https://doi.org/10.1016/j.ejvs.2009.03.004
11. Ye K, Lu X, Li W, Huang Y, Huang X, Lu M, Jiang M. Long-Term Outcomes of Stent Placement for Symptomatic Nonthrombotic Iliac Vein Compression Lesions in Chronic Venous Disease. Journal of Vascular and Interventional Radiology. 2012 04;23(4):497-502. https://doi.org/10.1016/j.jvir.2011.12.021
12. Rosales A, Sandbæk G, Jørgensen J. Stenting for Chronic Post-thrombotic Vena Cava and Iliofemoral Venous Occlusions: Mid-term Patency and Clinical Outcome. European Journal of Vascular and Endovascular Surgery. 2010 08;40(2):234-240. https://doi.org/10.1016/j.ejvs.2010.04.016
13. Kölbel T, Lindh M, Åkesson M, Wassèlius J, Gottsäter A, Ivancev K. Chronic Iliac Vein Occlusion:Midterm Results of Endovascular Recanalization. Journal of Endovascular Therapy. 2009 08;16(4):483-491. https://doi.org/10.1583/09-2719.1
14. Allegra C, Antignani P, Bergan JJ, Carpentier PH, Coleridge-Smith P, Cornu-Thénard A, Eklof B, Partsch H, Rabe E, Uhl J, Widmer M. The “C” of CEAP: Suggested definitions and refinements: An international union of phlebology conference of experts. Journal of Vascular Surgery. 2003 01;37(1):129-131. https://doi.org/10.1067/mva.2003.47
15. Gesto-Castromil R, García J. Encuesta epidemiológica realizada en España sobre la prevalencia asistencial de la insuficiencia venosa crónica en atención primaria. Estudio DETECT-IVC. Angiología. 2001 01;53(4):249-260. https://doi.org/10.1016/s0003-3170(01)74698-6
16. Browse N, Burnand K, Irvine A, Wilson N. Varicose veins: Pathology. Oxford University Press; 1999.
17. Cornu-Thenard A, Boivin P, Baud J, De Vincenzi I, Carpentier P. Importance of the familial factor in varicose disease. Clinical study of 134 families. Journal of Dermatology & Dermatologic Surgery. 1994;20(5):318-326.
18. Raffetto JD, Khalil RA. Mechanisms of varicose vein formation: valve dysfunction and wall dilation. Phlebology: The Journal of Venous Disease. 2008 04;23(2):85-98. https://doi.org/10.1258/phleb.2007.007027
19. Atta HM. Varicose Veins: Role of Mechanotransduction of Venous Hypertension. International Journal of Vascular Medicine. 2012;2012:1-13. https://doi.org/10.1155/2012/538627
20. Haviarova Z, Janegova A, Janega P, Durdik S, Kovac P, Stvrtinova V, Mraz P. Nitric oxide synthases in varicose vein wall. Bratislava Medical Journal. 2011;112(1):18-23.
21. Filis K, Kavantzas N, Isopoulos T, Antonakis P, Sigalas P, Vavouranakis E, Sigala F. Increased Vein Wall Apoptosis in Varicose Vein Disease is Related to Venous Hypertension. European Journal of Vascular and Endovascular Surgery. 2011 04;41(4):533-539. https://doi.org/10.1016/j.ejvs.2010.11.033
22. Evaluation of the smooth muscle cell component and apoptosis in the varicose vein wall. Histology and Histopathology. 2000 07 01;(33):745-752. https://doi.org/10.14670/HH-15.745
23. Ducasse E, Giannakakis K, Chevalier J, Dasnoy D, Puppinck P, Speziale F, Fiorani P, Faraggiana T. Dysregulated Apoptosis in Primary Varicose Veins. European Journal of Vascular and Endovascular Surgery. 2005 03;29(3):316-323. https://doi.org/10.1016/j.ejvs.2004.12.012
24. Harley B, Leung J, Silva E, GibsonI L. Mechanical characterization of collagen–glycosaminoglycan scaffolds. Acta Biomaterialia. 2007 07;3(4):463-474. https://doi.org/10.1016/j.actbio.2006.12.009
25. Wali M, Dewan M, Eid R. Histopathological changes in the wall of varicose veins. International Angiology. 2003;22(2):188-193.
26. Psaila JV, Melhuish J. Viscoelastic properties and collagen content of the long saphenous vein in normal and varicose veins. British Journal of Surgery. 1989 01;76(1):37-40. https://doi.org/10.1002/bjs.1800760112
27. Travers J, Brookes C, Evans J, Baker D, Kent C, Makin G, Mayhew T. Assessment of wall structure and composition of varicose veins with reference to collagen, elastin and smooth muscle content. European Journal of Vascular and Endovascular Surgery. 1996 02;11(2):230-237. https://doi.org/10.1016/s1078-5884(96)80058-x
28. Naim M, Elsharawy M. Histological assessment of the long saphenous vein in normal and varicosa veins. Egyptian Journal of Histology. 2005;28(2):281-290.
29. Martin SS, Alaminos M, Zorn TMT, Sánchez-Quevedo MC, Garzón I, Rodriguez IA, Campos A. The effects of fibrin and fibrin-agarose on the extracellular matrix profile of bioengineered oral mucosa. Journal of Tissue Engineering and Regenerative Medicine. 2011 Nov 03;7(1):10-19. https://doi.org/10.1002/term.490
30. Wali MA, Eid RA. Intimal Changes in Varicose Veins: An Ultrastructural Study.. Journal of Smooth Muscle Research. 2002;38(3):63-74. https://doi.org/10.1540/jsmr.38.63
31. Khan AA, Eid RA, Hamdi A. Structural changes in the tunica intima of varicose veins: a histopathological and ultrastructural study. Pathology. 2000;32(4):253-257. https://doi.org/10.1080/pat.32.4.253.257
32. Wali MA, Eid RA. Smooth Muscle Changes in Varicose Veins: An Ultrastructural Study. Journal of Smooth Muscle Research. 2001;37(5,6):123-135. https://doi.org/10.1540/jsmr.37.123
33. Brunner F, Hoffmann C, Schuller-Petrovic S. Responsiveness of human varicose saphenous veins to vasoactive agents. British Journal of Clinical Pharmacology. 2008 07 07;51(3):219-224. https://doi.org/10.1046/j.1365-2125.2001.00334.x
34. Sansilvestri-Morel P, Rupin A, Badier-Commander C, Kern P, Fabiani J, Verbeuren TJ, Vanhoutte PM. Imbalance in the Synthesis of Collagen Type I and Collagen Type III in Smooth Muscle Cells Derived from Human Varicose Veins. Journal of Vascular Research. 2001;38(6):560-568. https://doi.org/10.1159/000051092
35. Wali M, Dewan M, Eid R. Histopathological changes in the wall of varicose veins. International Angiology. 2003;22(2):188-193.
36. Gandhi RH, Irizarry E, Nackman GB, Halpern VJ, Mulcare RJ, Tilson M. Analysis of the connective tissue matrix and proteolytic activity of primary varicose veins. Journal of Vascular Surgery. 1993 Nov;18(5):814-820. https://doi.org/10.1016/0741-5214(93)90336-k
37. Krasiński Z, Biskupski P, Dzieciuchowicz Ł, Kaczmarek E, Krasińska B, Staniszewski R, Pawlaczyk K, Stanisić M, Majewski P, Majewski W. The Influence of Elastic Components of the Venous Wall on the Biomechanical Properties of Different Veins Used for Arterial Reconstruction. European Journal of Vascular and Endovascular Surgery. 2010 08;40(2):224-229. https://doi.org/10.1016/j.ejvs.2010.04.008
38. Sokolis DP. Experimental investigation and constitutive modeling of the 3D histomechanical properties of vein tissue. Biomechanics and Modeling in Mechanobiology. 2012 06 16;12(3):431-451. https://doi.org/10.1007/s10237-012-0410-y
39. Kirsch D, Wahl W, Böttger T, Junginger T. Primary varicose veins-changes in the venous wall and elastic behavior. Der Chirurg. 2000;71(5):305-306.
40. Hernández Rivero M, Llanes Barrios J, Quiñones Castro M. Caracterización de la insuficiencia venosa crónica en consultas del Instituto de Angiología y Cirugía Vascular. Revista Cubana de Angiología y Cirugía Vascular. 2010;11(1):1-9.
41. Wilmanns C, Cooper A, Wockner L, Katsandris S, Glaser N, Meyer A, Bartsch O, Binder H, Walter PK, Zechner U. Morphology and Progression in Primary Varicose Vein Disorder Due to 677C>T and 1298A>C Variants of MTHFR. EBioMedicine. 2015 02;2(2):158-164. https://doi.org/10.1016/j.ebiom.2015.01.006
42. Luebke T, Brunkwall J. Meta-analysis of subfascial endoscopic perforator vein surgery (SEPS) for chronic venous insufficiency. Phlebology: The Journal of Venous Disease. 2009 02;24(1):8-16. https://doi.org/10.1258/phleb.2008.008005
43. van Zuuren EJ, Fedorowicz Z, Pucci E, Jagannath VA, Robak EW. Percutaneous transluminal angioplasty for treatment of chron.
44. Martinez-Zapata MJ, Vernooij RW, Uriona Tuma SM, Stein AT, Moreno RM, Vargas E, Capellà D, Bonfill Cosp X. Phlebotonics for venous insufficiency. Cochrane Database of Systematic Reviews. 2016 04 06;. https://doi.org/10.1002/14651858.cd003229.pub3.