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Pathogenesis of primary varicose veins
1Imperial Vascular Unit, Imperial College London, 4 East, Charing Cross Hospital, Fulham Palace Road, London, UK.
The British Journal of Surgery
|October 23, 2009
Summary
Varicose vein development involves vein wall changes preceding valve issues. Key factors include smooth muscle cell proliferation, reduced elastin, and altered matrix metalloproteinases (MMPs) in affected veins.
Area of Science:
- Vascular Biology
- Pathophysiology
Background:
- Primary varicose veins are often linked to valvular incompetence and reflux.
- Emerging evidence suggests vein wall alterations may precede valvular dysfunction in varicose veins.
Purpose of the Study:
- To review the pathophysiology and etiology of varicose veins, focusing on vein wall changes.
- To identify potential therapeutic targets by understanding varicose vein pathogenesis.
Main Methods:
- A comprehensive literature search was conducted using PubMed and Ovid.
- Keywords included 'varicose vein wall changes', 'pathogenesis', 'aetiology', and 'valvular dysfunction'.
- Studies on complications like ulceration were excluded.
Main Results:
- Risk factors for varicose veins include family history, age, sex, and pregnancy.
- Varicose veins exhibit intimal hyperplasia, smooth muscle cell proliferation, reduced elastin, and uncertain collagen changes.
- Upregulation of matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs) was observed, alongside endothelial activation and dysregulated apoptosis.
Conclusions:
- Vein wall changes, including cellular proliferation and matrix remodeling, are central to varicose vein development.
- Understanding these pathophysiological mechanisms is crucial for developing new treatment strategies.
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