The Basic Scientists Are Leading the Way in Understanding, Prevention, and Treatment of Venous and Lymphatic Diseases

Abstract

Purpose Basic science contributes to knowledge and advances the field. This is not an exception in Phlebology. This manuscript highlights the latest contributions to the basic science on varicose veins.

Methods A brief non-systematic review of the literature in the area of basic science and varicose veins was performed using PubMed. We found critical articles that are discussed in this work. In addition, we discussed all the scientific method steps, the importance of each of them, and its application to the field of Phlebology. The basic science and varicose veinsʼ articles were discussed as basic science findings on vein wall, blood flow disturbances, and vein valve changes.

Results Altered vein wall in varicose veins results from the remodeling phenomenon, led by modifications at the vein wall cellular level and in the intercellular space. Smooth Muscle Cells are involved in this process, and a shift between contractile to secretory phenotype has been described. MMPs are actively engaged in the remodeling stage, contributing to the final modification of the vein wall observed in varicose veins. Finally, the blood flow characteristics and the vein valve functionality demonstrated an integrated system.

Conclusions The Scientific Method is the cornerstone of the basic science approach. Varicose veins result from altered blood flow and vein wall remodeling phenomenon.

Keywords

Basic Science - Phlebology - Multidisciplinary Team - Research - Varicose Veins

Publication History

Article published online:
10 August 2022

• References

• 1 Diaz JA. Basic-science leading the way for prevention and treatment of varicose veins. J Vasc Surg Venous Lymphat Disord 2021; 9: 252-253
• 2 Glynn RJ, Danielson E, Fonseca FA. et al. A Randomized Trial of Rosuvastatin in the Prevention of Venous Thromboembolism. NEJM 2009; 360: 1851-1861
• 3 Patterson KA, Zhang X, Wrobleski SK. et al. Rosuvastatin reduced deep vein thrombosis in ApoE gene deleted mice with hyperlipidemia through non-lipid lowering effects. Thrombosis Research 2013; 131: 268-276
• 4 Diaz JA. Invited commentary. J Vasc Surg Venous Lymphat Disord 2017; 5: 734
• 5 Robbesom AA, Koenders MMJF, Smits NC. et al. Aberrant fibrillin-1 expression in early emphysematous human lung: a proposed predisposition for emphysema. Modern Pathology 2007; 21: 297-307
• 6 Bastos AN, Alves MMR, Monte-Alto-Costa A. et al. α-smooth muscle actin, fibrillin-1, apoptosis and proliferation detection in primary varicose lower limb veins of women. Int Angiol 2011; 30: 262-271
• 7 Sansilvestri-Morel P, Rupin A, Badier-Commander C. et al. 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: 560-568
• 8 Haviarova Z, Janega P, Duedik S. et al. Comparison of collagen subtype I and III presence in varicose and non-varicose vein walls. Bratislava Medical Journal 2008; 109: 102-105
• 9 Kapeliotis M, Gavrila Laic RA, Peñas AJ. et al. Collagen fibre orientation in human bridging veins. Biomechanics and Modeling in Mechanobiology 2020; 19: 2455-2489
• 10 Horecka A, Hordyjewska A, Biernacka J. et al. Intense remodeling of extracellular matrix within the varicose vein: the role of gelatinases and vascular endothelial growth factor. Irish Journal of Medical Science 2021; 190: 255-259
• 11 Xu Y, Bei Y, Li Y. et al. Phenotypic and functional transformation in smooth muscle cells derived from varicose veins. J Vasc Surg Venous Lymphat Disord 2017; 5: 723-733
• 12 Guo Z, Luo C, Zhu T. et al. Elevated c-fos expression is correlated with phenotypic switching of human vascular smooth muscle cells derived from lower limb venous varicosities. J Vasc Surg Venous Lymphat Disord 2021; 9: 242-251
• 13 Xiao Y, Huang Z, Yin H. et al. In vitro differences between smooth muscle cells derived from varicose veins and normal veins. Journal of Vascular Surgery 2009; 50: 1149-1154
• 14 Urbanek T, Skop B, Wiaderkiewicz R. et al. Smooth muscle cell apoptosis in primary varicose veins. European Journal of Vascular and Endovascular Surgery 2004; 28: 600-611
• 15 Ortega MA, Romero B, Asúnsolo Á. et al. Behavior of smooth muscle cells under hypoxic conditions: Possible implications on the varicose vein endothelium. BioMed Research International 2018; 2018: 7156150
• 16 Eschrich J, Meyer R, Kuk H. et al. Varicose Remodeling of Veins Is Suppressed by 3-Hydroxy-3-Methylglutaryl Coenzyme A Reductase Inhibitors. J Am Heart Assoc 2016; 5: e002405
• 17 Tien WH, Chen HY, Berwick ZC. et al. Hemodynamic coupling of a pair of venous valves. J Vasc Surg Venous Lymphat Disord 2014; 2: 303-314
• 18 Chen HY, Diaz JA, Lurie F. et al. Hemodynamics of venous valve pairing and implications on helical flow. J Vasc Surg Venous Lymphat Disord 2018; 6: 517-522
• 19 Lurie F. Anatomical Extent of Venous Reflux. Cardiology and Therapy 2020; 9: 215
• 20 Tauraginskii RA, Simakov S, Borsuk D. et al. The immediate effect of physical activity on ultrasound-derived venous reflux parameters. J Vasc Surg Venous Lymphat Disord 2020; 8: 640-645
• 21 Diaz JA. Vascular surgery and the multidisciplinary vascular research team. Journal of Vascular Surgery: Venous and Lymphatic Disorders 2020; 8: 470-471
• 22 Cushman M, Barnes GD, Creager MA. et al. Venous thromboembolism research priorities: A scientific statement from the american heart association and the international society on thrombosis and haemostasis. Circulation 2020; 142: E85-94