Journal of Vascular Surgery
Volume 46, Issue 6, Supplement , Pages S54-S67 , December 2007

Primary chronic venous disorders

  • Mark H. Meissner, MD

      Affiliations

    • Department of Surgery, University of Washington School of Medicine, Seattle, Wash
    • Corresponding Author InformationCorrespondence: Mark H. Meissner, MD, Department of Surgery, Box 356410, University of Washington Medical Center, 1589 NE Pacific Street, Seattle, WA 98195.
  • ,
  • Peter Gloviczki, MD

      Affiliations

    • Mayo Clinic, Rochester, Minn
  • ,
  • John Bergan, MD

      Affiliations

    • University of California San Diego Medical School Scripps Memorial Hospital, La Jolla, Calif
  • ,
  • Robert L. Kistner, MD

      Affiliations

    • Straub Foundation Kistner Vein Clinic, Honolulu, Hawaii
  • ,
  • Nick Morrison, MD

      Affiliations

    • Morrison Vein Institute, Scottsdale Ariz
  • ,
  • Felizitas Pannier, MD

      Affiliations

    • University of Bonn, Bonn, Germany
  • ,
  • Peter J. Pappas, MD

      Affiliations

    • University of Medicine and Dentistry New Jersey, Newark, NJ
  • ,
  • Eberhard Rabe, MD

      Affiliations

    • University of Bonn, Bonn, Germany
  • ,
  • Seshadri Raju, MD

      Affiliations

    • private practice in Flowood, Miss, Jackson, Miss
  • ,
  • J. Leonel Villavicencio, MD

      Affiliations

    • Uniformed Services University School of Medicine Walter Reed Army and National Naval Medical Centers, Bethesda, Md.

Received 16 September 2006 ,Accepted 19 August 2007.

References 

  1. White GH. Chronic venous insufficiency. In:  Veith F,  Hobson RW,  Williams RA,  Wilson SE editor. Vascular surgery. 2nd ed.. New York: McGraw-Hill, Inc; 1993;p. 865–888
  2. Criqui MH, Jamosmos M, Fronek A, Denenberg JO, Langer RD, Bergan J, et al. Chronic venous disease in an ethnically diverse population: the San Diego Population Study. Am J Epidemiol. 2003;58:448–456
  3. Reporting standards in venous disease (Prepared by the Subcommittee on Reporting Standards in Venous Disease, Ad Hoc Committee on Reporting Standards, Society for Vascular Surgery/North American Chapter, International Society for Cardiovascular Surgery). J Vasc Surg. 1988;8:172–181
  4. Coon WW, Willis PW, Keller JB. Venous thromboembolism and other venous disease in the Tecumseh community health study. Circulation. 1973;48:839–846
  5. Hume M. A venous renaissance?. J Vasc Surg. 1992;15:947–951
  6. U.S. Department of Health and Welfare. The magnitude of chronic disease problems in the United States (National Health Survey 1935-1936 Preliminary Reports). 1938;Washington, DC
  7. Porter JM, Moneta GL. Reporting standards in venous disease: an update (International Consensus Committee on Chronic Venous Disease). J Vasc Surg. 1995;21:635–645
  8. Eklof B, Rutherford RB, Bergan JJ, Carpentier PH, Gloviczki P, Kistner RL, et al. Revision of the CEAP classification for chronic venous disorders: consensus statement. J Vasc Surg. 2004;40:1248–1252
  9. Rutherford RB, Padberg FT, Comerota AJ, Kistner RL, Meissner MH, Moneta GL. Venous severity scoring: An adjunct to venous outcome assessment. J Vasc Surg. 2000;31:1307–1312
  10. Beebe-Dimmer JL, Pfeifer JR, Engle JS, Schottenfeld D. The epidemiology of chronic venous insufficiency and varicose veins. Ann Epidemiol. 2005;15:175–184
  11. Evans CJ, Fowkes FG, Hajivassiliou CA, Harper DR, Ruckley CV. Epidemiology of varicose veins (A review). Int Angiol. 1994;13:263–270
  12. Evans CJ, Fowkes FG, Ruckley CV, Lee AJ. Prevalence of varicose veins and chronic venous insufficiency in men and women in the general population: Edinburgh Vein Study. J Epidemiol Community Health. 1999;53:149–153
  13. Fischer H. Venenleiden – Eine repräsentative Untersuchung in der Bundesrepublik Deutschland (Tübinger Studie). München: Urban und Schwarzenberg; 1981;
  14. Fowkes FG, Evans CJ, Lee AJ. Prevalence and risk factors of chronic venous insufficiency. Angiology. 2001;52(Suppl 1):S5–S15
  15. Heit JA, Rooke TW, Silverstein MD, Mohr DN, Lohse CM, Petterson TM, et al. Trends in the incidence of venous stasis syndrome and venous ulcer: a 25-year population-based study. J Vasc Surg. 2001;33:1022–1027
  16. Ruckley CV, Evans CJ, Allan PL, Lee AJ, Fowkes FG. Chronic venous insufficiency: clinical and duplex correlations (The Edinburgh Vein Study of venous disorders in the general population). J Vasc Surg. 2002;36:520–525
  17. Widmer LK, Stählin HB, Nissen C, Da Silva A. Venen-, Arterien-Krankheiten, koronare Herzkrankheit bei Berufstätigen, Prospektiv-epidemiologische Untersuchung Baseler Studie I-III 1959-1978. Bern: Verlag Hans Huber.
  18. Brand FN, Dannenberg AL, Abbott RD, Kannel WB. The epidemiology of varicose veins: the Framingham Study. Am J Prev Med. 1988;4:96–101
  19. Carpentier PH, Maricq HR, Biro C, Poncot-Makinen CO, Franco A. Prevalence, risk factors, and clinical patterns of chronic venous disorders of lower limbs: a population-based study in France. J Vasc Surg. 2004;40:650–659
  20. Jawien A, Grzela T, Ochwat A. Prevalence of chronic venous insufficiency in men and women in Poland: multicenter cross-sectional study in 40095 patients. Phlebology. 2003;18:110–121
  21. Rabe E, Pannier-Fischer F, Bromen K, Schuld K, Ponar C, Wittenhorst M, et al. Bonner Venenstudie der Deutschen Gesellschaft für Phlebologie – epidemiologische Untersuchung zur Frage der Häufigkeit und Ausprägung von chronischen Venenkrankheiten in der städtischen und ländlichen Wohnbevölkerung. Phlebologie. 2003;32:1–14
  22. Kistner RL, Eklof B, Masuda EM. Diagnosis of chronic venous disease of the lower extremities: the “CEAP” classification. Mayo Clin Proc. 1996;71:338–345
  23. Alexander CJ. The theoretical basis of varicose vein formation. Med J Aust. 1972;1:258–261
  24. Cotton LT. Varicose veins (Gross anatomy and development). Br J Surg. 1961;48:589–597
  25. Labropoulos N, Giannoukas AD, Delis K, Mansour MA, Kang SS, Nicolaides AN, et al. Where does venous reflux start?. J Vasc Surg. 1997;26:736–742
  26. Clarke GH, Vasdekis SN, Hobbs JT, Nicolaides AN. Venous wall function in the pathogenesis of varicose veins. Surgery. 1992;111:402–408
  27. Leu HJ, Vogt M, Pfrunder H. Morphological alterations of non-varicose and varicose veins. (A morphological contribution to the discussion on pathogenesis of varicose veins) Basic Res Cardiol. 1979;74:435–444
  28. Vanhoutte PM, Corcaud S, de Montrion C. Venous disease: from pathophysiology to quality of life. Angiology. 1997;48:559–567
  29. Ascher E, Jacob T, Hingorani A, Tsemekhin B, Gunduz Y. Expression of molecular mediators of apoptosis and their role in the pathogenesis of lower-extremity varicose veins. J Vasc Surg. 2001;33:1080–1086
  30. Bouissou H, Julian M, Pieraggi MT, Louge L. Vein morphology. Phlebology. 1988;3(Suppl 1):1–11
  31. Goldman MP, Fronek A. Anatomy and pathophysiology of varicose veins. J Dermatol Surg Oncol. 1989;15:138–145
  32. Jones GT, Solomon C, Moaveni A, van Rij AM, Thomson IA, Galvin I. Venous morphology predicts class of chronic venous insufficiency. Eur J Vasc Endovasc Surg. 1999;18:349–354
  33. Lowell RC, Gloviczki P, Miller VM. In vitro evaluation of endothelial and smooth muscle function of primary varicose veins. J Vasc Surg. 1992;16:679–686
  34. Porto LC, Azizi MA, Pelajo-Machado M, Matos da SP, Lenzi HL. Elastic fibers in saphenous varicose veins. Angiology. 2002;53:131–140
  35. Gandhi RH, Irizarry E, Nackman GB, Halpern VJ, Mulcare RJ, Tilson MD. Analysis of the connective tissue matrix and proteolytic activity of primary varicose veins. J Vasc Surg. 1993;18:814–820
  36. Travers JP, Brookes CE, Evans J, Baker DM, Kent C, Makin GS, et al. Assessment of wall structure and composition of varicose veins with reference to collagen, elastin and smooth muscle content. Eur J Vasc Endovasc Surg. 1996;11:230–237
  37. Barber DA, Wang X, Gloviczki P, Miller VM. Characterization of endothelin receptors in human varicose veins. J Vasc Surg. 1997;26:61–69
  38. Haardt B. A comparison of the histochemical enzyme pattern in normal and varicose veins. Phleboloby. 1987;2:135–158
  39. Michiels C, Arnould T, Thibaut-Vercruyssen R, Bouaziz N, Janssens D, Remacle J. Perfused human saphenous veins for the study of the origin of varicose veins: role of the endothelium and of hypoxia. Int Angiol. 1997;16:134–141
  40. Thomas PR, Nash GB, Dormandy JA. White cell accumulation in dependent legs of patients with venous hypertension: a possible mechanism for trophic changes in the skin. Br Med J (Clin Res Ed). 1988;296:1693–1695
  41. Burnand KG, Whimster I, Naidoo A, Browse NL. Pericapillary fibrin in the ulcer-bearing skin of the leg: the cause of lipodermatosclerosis and venous ulceration. Br Med J (Clin Res Ed). 1982;285:1071–1072
  42. Herrick SE, Sloan P, McGurk M, Freak L, McCollum CN, Ferguson MW. Sequential changes in histologic pattern and extracellular matrix deposition during the healing of chronic venous ulcers. Am J Pathol. 1992;141:1085–1095
  43. Higley HR, Ksander GA, Gerhardt CO, Falanga V. Extravasation of macromolecules and possible trapping of transforming growth factor-beta in venous ulceration. Br J Dermatol. 1995;132:79–85
  44. Leu HJ. Morphology of chronic venous insufficiency--light and electron microscopic examinations. VASA. 1991;20:330–342
  45. Leu AJ, Leu HJ, Franzeck UK, Bollinger A. Microvascular changes in chronic venous insufficiency--a review. Cardiovasc Surg. 1995;3:237–245
  46. Pappas PJ, DeFouw DO, Venezio LM, Gorti R, Padberg FT, Silva MB, et al. Morphometric assessment of the dermal microcirculation in patients with chronic venous insufficiency. J Vasc Surg. 1997;26:784–795
  47. Wilkinson LS, Bunker C, Edwards JC, Scurr JH, Smith PD. Leukocytes: their role in the etiopathogenesis of skin damage in venous disease. J Vasc Surg. 1993;17:669–675
  48. Bishop JE. Regulation of cardiovascular collagen deposition by mechanical forces. Mol Med Today. 1998;4:69–75
  49. Weckroth M, Vaheri A, Lauharanta J, Sorsa T, Konttinen YT. Matrix metalloproteinases, gelatinase and collagenase, in chronic leg ulcers. J Invest Dermatol. 1996;106:1119–1124
  50. Allegra C, Antignani PL, Bergan JJ, Carpentier PH, Coleridge-Smith P, Cornu-Thenard A, et al. The “C” of CEAP: suggested definitions and refinements: an International Union of Phlebology conference of experts. J Vasc Surg. 2003;37:129–131
  51. Labropoulos N, Mansour MA, Kang SS, Gloviczki P, Baker WH. New insights into perforator vein incompetence. Eur J Vasc Endovasc Surg. 1999;18:228–234
  52. Bays RA, Healy DA, Atnip RG, Neumyer M, Thiele BL. Validation of air plethysmography, photoplethysmography, and duplex ultrasonography in the evaluation of severe venous stasis. J Vasc Surg. 1994;20:721–727
  53. McDaniel HB, Marston WA, Farber MA, Mendes RR, Owens LV, Young ML, et al. Recurrence of chronic venous ulcers on the basis of clinical, etiologic, anatomic, and pathophysiologic criteria and air plethysmography. J Vasc Surg. 2002;35:723–728
  54. Iafrati MD, Welch H, O’Donnell TF, Belkin M, Umphrey S, McLaughlin R. Correlation of venous noninvasive tests with the Society for Vascular Surgery/International Society for Cardiovascular Surgery clinical classification of chronic venous insufficiency. J Vasc Surg. 1994;19:1001–1007
  55. van Bemmelen PS, Mattos MA, Hodgson KJ, Barkmeier LD, Ramsey DE, Faught WE, et al. Does air plethysmography correlate with duplex scanning in patients with chronic venous insufficiency?. J Vasc Surg. 1993;18:796–807
  56. Labropoulos N, Volteas N, Leon M, Sowade O, Rulo A, Giannoukas AD, et al. The role of venous outflow obstruction in patients with chronic venous dysfunction. Arch Surg. 1997;132:46–51
  57. Kamida CB. Lower extremity ascending and descending venography. In:  Gloviczki P,  Yao JST editor. Handbook of venous disorders. 2nd ed.. London: Arnold; 2001;p. 132–139
  58. Labropoulos N, Leon M, Nicolaides AN, Giannoukas AD, Volteas N, Chan P. Superficial venous insufficiency: correlation of anatomic extent of reflux with clinical symptoms and signs. J Vasc Surg. 1994;20:953–958
  59. Bergan JJ. Etiology and surgical management of varicose veins. In:  Hobson R,  Wilson SE,  Veith FJ editor. Vascular surgery: principles and practice. New York: Marcel Decker; 2004;
  60. Fischer R, Linde N, Duff C, Jeanneret C, Chandler JG, Seeber P. Late recurrent saphenofemoral junction reflux after ligation and stripping of the greater saphenous vein. J Vasc Surg. 2001;34:236–240
  61. Bergan JJ, Pascarella L. Varicose vein surgery. In:  Wilmore D,  Souba W,  Fink M editor. ACS Surgery Online. New York: WebMD, Inc; 2003;
  62. Cheatle T. The long saphenous vein: to strip or not to strip?. Semin Vasc Surg. 2005;18:10–14
  63. Stonebridge PA, Chalmers N, Beggs I, Bradbury AW, Ruckley CV. Recurrent varicose veins: a varicographic analysis leading to a new practical classification. Br J Surg. 1995;82:60–62
  64. Fischer R, Chandler JG, De Maeseneer MG, Frings N, Lefebvre-Vilarbedo M, Earnshaw JJ, et al. The unresolved problem of recurrent saphenofemoral reflux. J Am Coll Surg. 2002;195:80–94
  65. Chandler JG, Pichot O, Sessa C, Schuller-Petrovic S, Kabnick LS, Bergan JJ. Treatment of primary venous insufficiency by endovenous saphenous vein obliteration. Vasc Surg. 2000;34:201–214
  66. Glass GM. Neovascularization in recurrent saphenofemoral incompetence of varicose veins: surgical anatomy and morphology. Phlebology. 1995;10:136–142
  67. Jones L, Braithwaite BD, Selwyn D, Cooke S, Earnshaw JJ. Neovascularisation is the principal cause of varicose vein recurrence: results of a randomized trial of stripping the long saphenous vein. Eur J Vasc Endovasc Surg. 1996;12:442–445
  68. Nyamekye I, Shephard NA, Davies B, Heather BP, Earnshaw JJ. Clinicopathological evidence that neovascularisation is a cause of recurrent varicose veins. Eur J Vasc Endovasc Surg. 1998;15:412–415
  69. Tessari L, Cavezzi A, Frullini A. Preliminary experience with a new sclerosing foam in the treatment of varicose veins. Dermatol Surg. 2001;27:58–60
  70. van Rij AM, Jones GT, Hill GB, Jiang P. Neovascularization and recurrent varicose veins: more histologic and ultrasound evidence. J Vasc Surg. 2004;40:296–302
  71. Sarin S, Scurr JH, Coleridge Smith PD. Stripping of the long saphenous vein in the treatment of primary varicose veins. Br J Surg. 1994;81:1455–1458
  72. Frullini A, Cavezzi A. Sclerosing foam in the treatment of varicose veins and telangiectases: history and analysis of safety and complications. Dermatol Surg. 2002;28:11–15
  73. Kistner RL. Endovenous obliteration of the greater saphenous vein: the closure procedure. Jpn J Phlebol. 2002;13:325–333
  74. Proebstle TM, Gul D, Lehr HA, Kargl A, Knop J. Infrequent early recanalization of greater saphenous vein after endovenous laser treatment. J Vasc Surg. 2003;38:511–516
  75. Lurie F, Creton D, Eklof B, Kabnick LS, Kistner RL, Pichot O, et al. Prospective randomized study of endovenous radiofrequency obliteration (closure procedure) versus ligation and stripping in a selected patient population (EVOLVeS Study). J Vasc Surg. 2003;38:207–214
  76. Lurie F, Creton D, Eklof B, Kabnick LS, Kistner RL, Pichot O, et al. Prospective randomized study of endovenous radiofrequency obliteration (closure) versus ligation and vein stripping (EVOLVeS): 2-year follow-up. Eur J Vasc Endovasc Surg. 2005;29:67–73
  77. Merchant RF, Pichot O. Long-term outcomes of endovenous radiofrequency obliteration of saphenous reflux as a treatment for superficial venous insufficiency. J Vasc Surg. 2005;42:502–509discussion 9
  78. Merchant RF, DePalma RG, Kabnick LS. Endovascular obliteration of saphenous reflux: a multicenter study. J Vasc Surg. 2002;35:1190–1196
  79. Min RJ, Zimmet SE, Isaacs MN, Forrestal MD. Endovenous laser treatment of the incompetent greater saphenous vein. J Vasc Interv Radiol. 2001;12:1167–1171
  80. Min RJ, Khilnani N, Zimmet SE. Endovenous laser treatment of saphenous vein reflux: long-term results. J Vasc Interv Radiol. 2003;14:991–996Aug
  81. Navarro L, Min RJ, Bone C. Endovenous laser: a new minimally invasive method of treatment for varicose veins--preliminary observations using an 810 nm diode laser. Dermatol Surg. 2001;27:117–122
  82. Morrison N. Comparative study of radiofrequency vs laser ablation of the greater saphenous vein (Liverpool endovascular masterclass, 2004). 2004;Liverpool, UK
  83. Weiss RA, Weiss MA. Controlled radiofrequency endovenous occlusion using a unique radiofrequency catheter under duplex guidance to eliminate saphenous varicose vein reflux: a 2-year follow-up. Dermatol Surg. 2002;28:38–42
  84. Morrison N. Saphenous vein obliteration by light energy. 2004;17th Annual International Congress on Endovascular Interventions; 2004; Scottsdale, Ariz
  85. Villavicencio JL, Spence R, Pfeifer JR, Lohr JM, Cranley R, Goldman MP. Sclerotherapy for varicose veins: guidelines and procedures. In:  Raju S,  Villavicencio JL editor. Surgical management of venous disease. Media, (PA): Williams and Wilkkins; 1997;p. 221–246
  86. Orback EJ. Sclerotherapy of varicose veins: Utilization of intravenous air block. Am J Surg. 1944;66:362–366
  87. Cabrera Garrido JA, Cabrera Garrido-Olmedo JR, Garcia Olmedo Dominguez MA. Elargissement des limites de la sclerotherapie: nouveaux produits sclerosants. Phlebologie. 1997;50:181–188
  88. Frullini A. Foam sclerotherapy: a review. Phlebolymphology. 2003;40:125–129
  89. Trinidad M, Trinidad MJ, Villavicencio JL. Total foam sclerotherapy in a bloodless field: midterm results. 2005;American Venous Forum Annual Meeting. San Diego, CA
  90. Cavezzi A, Frullini A, Ricci S, Tessari L. Treatment of varicose veins by foam sclerotherapy: two clinical series. Phlebology. 2002;17:13–18
  91. Waugh JM. Ligation and injection of great saphenous veins. Proc Staff Meet Mayo Clinic. 1941;16:832
  92. Einarsson E, Eklof B, Neglen P. Sclerotherapy or surgery for varicose veins: a prospective randomized study. Phlebology. 1993;8:22–26
  93. Hobbs JT. Surgery and sclerotherapy in the treatment of varicose veins (A random trial). Arch Surg. 1974;109:793–796
  94. Breu FX, Guggenbichler S, Marshall M. Konsensuskonferez zur schaumsklerotherapie. Phlebologie. 2004;33:705–707
  95. Monfreux A. Traitement sclerosant des troncs sapheniens et leurs collaterals de gross caliber par le methode mus. Phlebologie. 1997;50:351–353
  96. Christopoulos D, Nicolaides AN, Galloway JM, Wilkinson A. Objective noninvasive evaluation of venous surgical results. J Vasc Surg. 1988;8:683–687
  97. Eriksson I. Reconstructive venous surgery. Acta Chir Scand Suppl. 1988;544:69–74
  98. Kistner RL. Primary venous valve incompetence of the leg. Am J Surg. 1980;140:218–224
  99. Masuda EM, Kistner RL. Long-term results of venous valve reconstruction: a 4- to 21-year follow-up. J Vasc Surg. 1994;19:391–403
  100. Neglen P, Egger JF, Olivier J, Raju S. Hemodynamic and clinical impact of ultrasound-derived venous reflux parameters. J Vasc Surg. 2004;40:303–310
  101. Neglen P, Thrasher TL, Raju S. Venous outflow obstruction: an underestimated contributor to chronic venous disease. J Vasc Surg. 2003;38:879–885
  102. Perrin M. Reconstructive surgery for deep venous reflux: a report on 144 cases. Cardiovasc Surg. 2000;8:246–255
  103. Raju S, Berry MA, Neglen P. Transcommissural valvuloplasty: technique and results. J Vasc Surg. 2000;32:969–976
  104. Raju S, Fountain T, Neglen P, Devidas M. Axial transformation of the profunda femoris vein. J Vasc Surg. 1998;27:651–659
  105. Raju S, Fredericks RK, Hudson CA, Fountain T, Neglen PN, Devidas M. Venous valve station changes in “primary” and post-thrombotic reflux: an analysis of 149 cases. Ann Vasc Surg. 2000;14:193–199
  106. Raju S, Fredericks RK, Neglen PN, Bass JD. Durability of venous valve reconstruction techniques for “primary” and post-thrombotic reflux. J Vasc Surg. 1996;23:357–366discussion 66-7
  107. Raju S, Neglen P, Doolittle J, Meydrech EF. Axillary vein transfer in trabeculated post-thrombotic veins. J Vasc Surg. 1999;29:1050–1062discussion 62-4
  108. Sottiurai VS. Surgical correction of recurrent venous ulcer. J Cardiovasc Surg (Torino). 1991;32:104–109
  109. Raju S, Neglen P, Carr-White PA, Fredericks RK, Devidas M. Ambulatory venous hypertension: component analysis in 373 limbs. Vasc Surg. 1999;33:257–267

 Competition of interest: none

PII: S0741-5214(07)01369-9

doi: 10.1016/j.jvs.2007.08.038

Journal of Vascular Surgery
Volume 46, Issue 6, Supplement , Pages S54-S67 , December 2007