Abstract:
Introduction: Varicose disease remains an actual pathology due to high incidence, possible
complications and also damage to the quality of life. The basic treatment of varicose veins is surgical
one. According to retrospective observations, about 35% of patients over 2-5 years after the surgery
develop recurrent varicose veins with pathologic reflux at the sapheno-femural junction (SFJ). Relapsed
venous reflux at SFJ can lead to severe venous insufficiency and recurrent venous disease.
Materials and methods: The study included 26 patients with venous disease in the basin of great
saphenous vein in both legs, taking part to class C2-C3, according to CEAP classification (Clinical-
Etiology-Anatomy-Pathophysiology). To the patients with a defect in the SFJ and a great saphenous vein
reflux, confirmed by Doppler Duplex scanning, was performed the crossectomy and striping in
combination with mini-phlebectomy to remove the dilated veins. In all patients were performed both
methods of prevention of the phenomenon of neovascularization: anatomical barrier and selective
crossectomy, either on the left or right leg. Vascular endothelial growth factors (VEGF-C/VEGF-D)
were determined by immunohistochemical methods through monoclonal antibodies.
Results: One month later after the surgery have been effectuated Duplex scanning to all patients,
for the control of performed crossectomy, which demonstrated a lack of residual affluents. One year
after the surgery in 15.2% of patients were detected visible varices at the thigh, while the phenomenon
of neovascularization, confirmed by Doppler Duplex scanning, was detected in 22.9% patients. After
two years the frequency of phenomenon of neovascularization was 34.5% (23% selective crossectomy
and anatomical barrier-11.5%). In these patients, plasma levels of VEGF-C/VEGF-D was increased, which confirms the role of these factors in the pathogenesis of the phenomenon of neovascularization
and recurrent varicose veins.
Conclusion: In addition to surgical treatment of varicose veins, which includes various methods
of prevention of the phenomenon of neovascularization (anatomical barriers, selective crossectomy,
endothelial inversion), antiangiogenic therapy gets a new large aspect directed towards receptors
VEGFR-3 and its ligands VEGF-C/VEGF-D. They are directly involved in the process of formation of
new, tortuous vessels and development of severe venous insufficiency.
Key words: Endothelial growth factors, neovascularization, varices.
Description:
Pathophysiology and Clinical Pathophysiology Department, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova, The 6th International Medical Congress for Students and Young Doctors
