Varicose Veins Pathophysiology

Prepared by Joseph Raffetto, MD
Corresponding chapter in Handbook of Venous Disorders: Chapters 5, 6 and 7

Ono T, Bergan JJ, Schmid-Schönbein GW, Takase S. Monocyte infiltration into venous valves.  J Vasc Surg 1998;27:158-66.

PMID: 9474094
Comment: This important study demonstrated the importance of leukocytes infiltration in the wall and valves of patients with primary venous insufficiency, and the morphologic valvular changes associated with varicose veins.

Sansilvestri-Morel P, Rupin A, Badier-Commander C, Kern P, Fabiani JN, 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. J Vasc Res 2001;38:560-8.

PMID: 11740155
Comment: An important study demonstrating the imbalance between type I and type III collagen in varicose veins, contributing to loss of elasticity, smooth muscle dysregulation, and potential implications in varicose veins.

Raffetto JD, Qiao X, Koledova VV, Khalil RA. Prolonged increases in vein wall tension increase matrix metalloproteinases and decrease constriction in rat vena cava: Potential implications in varicose veins. J Vasc Surg 2008;48:447-56.

PMID: 18502086
Comment: This important study evaluates the relationship between increased venous wall tension, overexpression of metalloproteinases, and decreased venous wall contraction in a rat inferior vena cava as a potential mechanism for venous dilation in varicose veins.

Lim CS, Davies AH. Pathogenesis of primary varicose veins. Br J Surg 2009;96:1231-42.

PMID: 19847861
Comment: This very well written and comprehensive review, evaluates the role of family history, metalloproteinases, structural protein changes, and apoptosis in the etiology for varicose vein formation.

Raffetto JD, Khalil RA. Mechanisms of varicose vein formation: valve dysfunction and wall dilation. Phlebology 2008;23:85-98.

PMID: 18453484
Comment: This review provides evidence based information on potential mechanisms leading to varicose vein formation, including genetics, clinical diagnostics, inflammatory and biochemical venous wall changes, and the role of matrix metalloproteinases.