Research about the different aspects of a disease process is important to help determine ways to manage the disease and other health conditions associated with it. Chronic venous insufficiency, for instance, is a multifactorial disease that is governed by many factors, from genetics to lifestyle.
So how does your immune system affect chronic vein insufficiency? Inflammatory processes result in the development of incompetent valves. This in turn leads to the development of chronic venous insufficiency or varicose veins. Immunological aspects of the development of varicose veins include vein wall remodeling, cytokine release, hypoxic environment, as well as the theory of “leukocyte trapping”.
Immunological Aspects Of Chronic Venous Insufficiency
Understanding the immune responses associated with chronic venous insufficiency is important to also understand the mechanisms behind this venous disease, especially as its exacerbation may lead to venous leg ulcers. Immunological processes that are important in the development of varicose veins include “leukocyte trapping”, vein wall remodeling, and cytokine release.
1) Leukocytes Involved In Chronic Venous Insufficiency
The role of white blood cells in chronic venous insufficiency is an interesting aspect to ponder regarding disease causation, as these also play a role in the pathology of other diseases.
T cells, which mature in the thymus, a lymphoid organ, may have a role in the disease causation despite the observed similarity of their levels in varices and in healthy veins. This is because they’re observed to localize differently with age.
These cells are localized in the subendothelium and in the valves in the older group. In the younger group, they’re localized in the adventitial and medial layers. It’s also speculated that it’s not the levels but the activities of the cells that are important in disease causation.
Similarly, the role of neutrophils in the causation of chronic venous insufficiency pathogenesis is also established, in a mechanism called the “leukocyte trap”. In this hypothesis, the factors associated with CVI, such as high blood pressure, hypoxia, and stasis, lead to an increased level of activation and infiltration of neutrophils in the endothelium.
2) Cytokines Involved In Chronic Venous Insufficiency
The transcription, amount, and activities of certain cytokines such as IL-8, TNF-α, GM-CSF, IFN-α2, MIP-1β, VEGF, EGF, Eotaxin, MCP-1, PDGF, and RANTES are elevated in incompetent veins and are associated with the exacerbation of the symptoms related to varicose veins.
3) Vein Wall Remodeling
The impairment in the activity of the white blood cells and the molecular factors released by platelets and macrophages result in the proinflammatory activity of the endothelium. These inflammatory changes result in the following:
- damage of the endothelial barrier leading to the loss of anticoagulatory properties
- formation of fibrinogen cuffs around the vein due to the release of proteolytic enzymes and toxic metabolites
- degeneration of the internal layer of the vein, characterized by a deformed, fragmented structure
Implication For Treatment Of Chronic Venous Insufficiency
More effective treatments and pharmacologic agents may be determined upon the elucidation of the immunological aspects of chronic venous insufficiency. In fact, clinical trials are being undergone to look for anti-inflammatory properties of the following substances and their possible role in addressing CVI:
- Vitamin C – Vitamin C may help in maintaining a healthy tissue of a blood vessel due to its antioxidant properties and ability to stimulate collagen synthesis (collagen is an important component of the extracellular matrix of body tissues including the blood vessels).
- Flavonoids – Flavonoids, when administered for 60 days, are observed to decrease the levels of endothelium activation markers (ICAM and VCAM). They also have antioxidant properties and can also prevent the formation of a hypoxic environment due to neutrophil infiltration and free radical formation.
- Glycosaminoglycan-sulodexide (SDX) – The release of the molecules secreted by macrophages such as cytokines, chemokines, and adhesive molecules are prevented by SDX. Moreover, it’s also worth noting that sulodexide alone has antithrombotic and profibrinolytic properties.
Signs And Symptoms Of Chronic Venous Insufficiency
Varicose veins are the most observable and representative manifestation, although other abnormal leg veins may also be seen such as telangiectasia (fine pink or red lines of veins more commonly known as spider veins) and reticular veins (an abnormal vein with size in between varicose veins and spider veins).
As chronic vein insufficiency (CVI) progresses, skin manifestations also may be observed such as:
- Eczema and pigmentation (due to hemosiderin deposits)
- Lipodermatosclerosis (an inflammation of subcutaneous fat associated with CVI)
- Corona phlebectatica (abnormal skin blood vessels of the ankles with components namely “venous cups”, blue and red spider veins, and capillary “stasis spots”)
- Formation of cancer cells of the skin characterized by skin degeneration
Moreover, other medical conditions may also arise directly or indirectly due to CVI such as:
- Leg pain
- Venous ulcer – This venous disease occurs ultimately as a result of CVI. It’s caused by the occlusion of blood vessels that in turn cause poor delivery of oxygen to the skin.
- Anxiety and depression – These psychiatric diseases aren’t directly caused by CVI per se, but they’re indirectly associated with this disease due to the aesthetic concerns surrounding the skin manifestations of the disease.
How Chronic Venous Insufficiency Is Diagnosed
The first step in establishing the diagnosis of chronic venous insufficiency is by obtaining adequate medical evidence of the disease through careful history-taking. Through this procedure, the presence of risk factors such as allergies, previous medications, family history of CVI, and other relevant medical conditions such as cardiovascular disease are assessed.
Another method to be done will be the physical examination and assessment of signs and symptoms associated with CVI. A standardized and accurate method of classification called the CEAP classification is used globally to determine the level of severity of the disease, using criteria namely clinical (C), etiological (E), anatomical (A), and pathophysiological (P). Its main limitation, however, is that it’s a subjective method with large intraobserver variability and mainly depends on the experience of the physician.
Diagnostic imaging test procedures are also used such as:
- Color duplex ultrasound (CDU) – This is the diagnostic technique of choice because of its non-invasive nature and ease of use. It’s used to know the proper treatment plan for the patient and to know if the vascular disorder of other body systems (such as the abdomen or pelvic areas) also exists in conjunction with CVI.
- Plethysmography – Valuable in distinguishing among venous reflux, obstruction, or muscle pump dysfunction.
- Computed tomography venography or magnetic resonance imaging – These use of diagnostic modalities are preferred for more complex cases such as prominent venous alterations, malformations, or if other organ systems are also affected.
Prevention Of Chronic Venous Insufficiency
As with other health conditions, chronic venous insufficiency may be addressed if it’s prevented before the common symptoms are observable. Ways to prevent the exacerbation of this venous condition include the combination of the following:
- Regular exercise – Lack of exercise increases the chances that an individual may present with CVI because of impaired blood flow associated with prolonged periods of standing or sitting. Moreover, regular exercise also helps an individual maintain a healthy weight. Activities of daily living may also be incorporated with a more active approach should you be too busy to exercise regularly.
- Elevate your legs – Elevating the legs above the heart level helps for better blood flow.
- Observe proper posture – Legs must not be crossed when seated to avoid impairments in blood flow.
Vein Center Doctor: Offering Professional Outpatient Vein Treatments
At Vein Center Doctor, we’re composed of a team of physicians, headed by Dr. Rahul Sood, that are experts in the medical treatment of chronic venous insufficiency and other vascular conditions.
We work together with our patients to determine the right treatment plan where they will have a good response to treatment to help their veins get back their healthy blood flow. We provide compassionate and expert care combined with the latest effective treatments namely radiofrequency ablation, endovenous laser treatment, sclerotherapy, VenaSeal, and compression therapy.
1) Radiofrequency Ablation
Radiofrequency ablation is an FDA-approved, minimally-invasive procedure that prevents saphenous vein reflux. It involves vein stripping with the help of diagnostic imaging (usually Doppler ultrasound) to deliver heat from radiofrequency catheters. This procedure only requires local anesthesia and doesn’t need regional anesthesia.
This procedure, however, must be avoided by individuals with a superficial vein diameter of less than 2 mm, medical history of deep vein thrombosis, and other medical conditions such as pregnancy and known malignancy. This procedure can’t also be done on the same leg where a prior endovenous treatment has already been done.
2) Endovenous Laser Treatment
Endovenous laser treatment is another procedure facilitated with an acceptable imaging technique that uses heat to shrink incompetent veins through scar tissue formation that shrinks blood vessels and redirect blood flow to other blood vessels.
In contrast to radiofrequency ablation, this technique uses a laser delivered through a catheter to provide the heat energy required to produce the effect previously described. The area will be covered by bandages after the procedure although there’s no need to stitch it. Some side effects of the procedure include bruising, nerve damage, and blood clot, which resolve in a few days time.
3) Sclerotherapy
Sclerotherapy involves the injection of a salt solution using a very fine needle directly over the area of concern. This is done to irritate the endothelium to cause shrinkage of the blood vessel and redirect the blood flow to other healthier blood vessels.
This procedure lasts for approximately 15 to 30 minutes and is affected by the size and location of veins and the condition of the patient. Side effects associated with this procedure are injection site reactions, which include raised, red areas, bruising, and itching at the injection sites.
4) VenaSeal
The VenaSeal closure system is a minimally invasive procedure that involves the delivery of 0.1cc of VenaSeal adhesive every 3 cm for 3 seconds, followed by the compression of the area where it was administered for 3 minutes.
It has minimal to no side effects including bruising as it doesn’t use heat or anesthesia. It also doesn’t require the use of compression stockings after the procedure.
5) Compression Therapy
Compression therapy, the standard of care for chronic venous insufficiency, aims to have patient-centered care that involves reduction of tissue swelling of the limbs and the maintenance of the size acquired upon reduction of swelling through the use of compression garments (such as compression bandages and compression stockings) and other devices.
It operates under two mechanisms namely compression of the legs during periods of inactivity and increasing the calf and foot muscle pumps during active periods. Types of compression systems include inelastic, elastic, single component, and multicomponent systems.
Despite its benefits, however, it should be avoided by individuals with arterial disease and uncompensated congestive heart failure.
Get Expert Outpatient Vein Care At Vein Center Doctor
Determining the immunological aspect that leads to incompetent veins can help healthcare providers to envision preventive and treatment options to manage varicose veins. This entails determining how cells and proteins operate in the blood vessels for them to become possible targets for drugs or therapy.
At Vein Center Doctor, we combine professional vein care with the latest technologies that can help address various types of vascular disease. Start your journey towards healthy veins today by contacting us at 862-227-1143 (NJ) or 862-227-1054 (NY) for your free consultation.
