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Venous disease can manifest itself in unusual ways; three uncommon venous disease states are described, together with discussions of their treatment. The cases include an iliac compression syndrome, incipient venous gangrene of an upper limb associated with polycythemia and congestive cardiac failure, and venous edema of a lower limb as a sequel to previous radical pelvic surgery.
Venous aberrations in the lower extremity, whether acute or chronic, have disastrous effects on individual patients, their families, and society in general. Whether the challenge is the treatment of varicose veins or that of maintaining patency of a venous reconstruction, it is obvious that many questions remain unanswered. Additional experimental research and clinical experience must be documented in carefully organized scientific studies.
Venous diseases of the lower extremities have been studied haemodynamically by analysis of variations in dynamic venous pressure, which is held to be a fundamental parameter. Pressure modifications point to the state of the deep venous system, the valves and the subfascial communicating veins or to the efficiency or otherwise of the muscular pump of the lower extremities. The venous pressure curve is a reliable indicator of the various clinical stages of chronic venous insufficiency and postphlebitis syndrome. As a clinical parameter, venous pressure is sensitive to all pathological changes in the venous system of the lower extremities. It presents variations proportional to the gravity of pure phlebopathies and of venous diseases secondary to congenital dysplasias (e.g. Klippel-Trenauny syndrome) and to congenital or acquired arteriovenous shunts. An attempt is made to classify venous diseases of the lower extremities on the basis of this parameter and examples are given of dynamic venous pressure curves encountered in the various disease pictures observed.
BACKGROUND: Chronic venous disease (CVD) arises from venous hypertension secondary to impaired venous return, causing significant morbidity and diminished quality of life. Genetic factors are likely important in the pathogenesis and susceptibility of a patient to develop CVD. This systematic review summarizes genome-wide association studies (GWASs) that investigate the link between genetic variants and CVD. METHODS: A systematic review was conducted in accordance with the PRISMA guidelines, with the search dates ranging from January 1, 1994, to July 17, 2025. Abstract and full-text screening were completed by two independent reviewers, with any conflicts referred to a third senior reviewer. GWASs in adults investigating links between genetic variants and CVD were included. Exclusion criteria included patients with venous thromboembolism, arterial or diabetic disease, or animal models. RESULTS: Thirteen studies were included after screening 517 studies from a search of PubMed, EMBASE, and Ovid. Database sources included UK Biobank, FinnGen, PopGen, and country- or hospital-specific databases with a majority Caucasian and European patient cohort. A total of 602,760 patients were identified with varicose veins and 3,664,604 control cases that were studied with GWASs and other statistical methods including a two-sample Mendelian randomization approach, functional mapping, and genetic correlations. A variety of statistically significant genetic polymorphisms were identified that can be attributed to the heritability of varicose veins affecting inflammation and immunity (eg, PPP3R1, EBF1, and GATA2), hypertension (eg, CASZ1), and vascular architecture (eg, CASZ1, PIEZO1, and STIM2). Protective variants (eg, GJD3, MMP10, and 4EBP1) were also identified in Finnish populations. However, replication studies showed that these genetic polymorphisms are not generalizable to specific populations. CONCLUSIONS: This systematic review highlights genes contributing to the development of CVD that have been identified in the literature. An improved understanding of genetic contributions to the pathogenesis of CVD may inform future diagnostics, prognostics, and personalized treatment. Further larger scale studies representative of global populations, including meta-analyses of genome-wide association datasets, are required owing to individual GWASs being statistically insufficient to draw generalizable conclusions.
The measurement of supine pedal venous pressure as a screening test for deep venous thrombosis is re-evaluated. In 83 extremities studied in 50 patients, the false-positive rate was 62%, the false-negative rate 8%. Chronic venous disease, whatever its etiology but particularly in association with the post-phlebitis syndrome, can be a source of error in relying upon this measurement.
In spite of the fact that they appear to have nothing in common, treatment by water from mineral springs and surgery may sometimes be used in combination against certain venous diseases. The spa phlebologist may suggest the indication for operation, c.q. prepare his patients for it by means of special cures. Also, spa treatments may help consolidate the early results of surgery, or combát possible complications (e.g. post-phlebitic complications); in such cases, the spa treatment should be instituted as early as possible.
The Doppler ultrasound is a proper method to diagnose pathologic venous flow in the pelvic and and femoral regions. It is possible to differentiate deep vein thrombosis and chronic venous insufficiency of the typical kind of disturbance. This method permits only functional but not morphological findings; it offers the chance of preselection to other invasive methods.
The described method of vetrical streophlebography, added with the contrasting of the limb surface, allows to reveal the space interrelationship between different veins, veins and bones and also between the limb and the body surface. The authors believe that due to the spacious image of the venous system of the lower limbs, stereoplebography is a more informative angiographic method as compared to a routine phlebography.
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The method of radionuclide venography is best determined by the localisation and type of suspected venous abnormality. The authors describe four methods using 99mTc microspheres and 99mTc-pertechnetate. Correlation of the isotope and angiographic findings in 150 patients indicated an accuracy of 90% for the isotope methods. The risks of radionuclide venography are discussed. Isotope venography is recommended as a simple, non-invasive technique.
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The data obtained evidence that the tone of the arterial vessels increases in 55% of patients with decompensated varicose dilatation of the lower extremity veins. In the postthrombophlebitic disease the arterial tone is disturbed in 80% of patients. It is supposed that the spasm of the arterial vessels of the lower extremities in chronic phlebopathology is a compensatory-adaptational response to the deteriorated venous outflow.
Radiological diagnostic methods for the diagnosis of abnormalities of veins were discussed in the light of 1,683 contrast venograms and isotope examinations in 650 patients with acute and chronic diseases of veins. For patients with increased thrombotic risks, the 125 I-fibrinogen test is recommended as a sensitive and simple method. Where there are symptoms of venous thrombosis, radionuclide venography, together with other noninvasive methods, may be used for establishing whether there are indications for contrast venography. These may also provide evidence of previous pulmonary emboli. These methods should also be used where there is clinical suspicion of previous pulmonary emboli. Non-invasive isotope methods have proved to be sensitive techniques for preliminary examinations and for follow-up. Contrast venography is necessary if definitive treatment is planned.
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The frequency of scintigraphic findings in the presence of thromboses, post-thrombotic changes and in normal veins, was determined in 150 patients. The results of radionuclide venography and contrast venography in these patients have been compared. Abnormalities in veins can be detected by radionuclide venography with a high degree of accuracy. Differentiation between acute and chronic thrombosis and post-thrombotic changes can only be made by invasive contrast venography.
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