Generic placeholder image

Current Cardiology Reviews


ISSN (Print): 1573-403X
ISSN (Online): 1875-6557

Review Article

Symptoms in Dilating Venous Disease

Author(s): Ertan Yetkin*, Selcuk Ozturk, Bilal Cuglan and Hasan Turhan

Volume 16, Issue 3, 2020

Page: [164 - 172] Pages: 9

DOI: 10.2174/1573403X16666200312101245

Price: $65


Lower extremity venous diseases or insufficiency include clinically deteriorating conditions with morphological and functional alterations of the venous system, including venous hypertension, vascular wall structural abnormality, and venous valvar incompetency in association with an inflammatory process. In fact, the same pathophysiological processes are the main underlying mechanisms of other venous insufficiencies in different vascular territories such as Peripheral Varicose Vein (PVV), varicocele, Pelvic Varicosities or Congestion Syndrome (PCS) and Hemorrhoidal Disease (HD). Regarding the anatomical continuity of lower extremity venous system, urogenital system (pampiniform plexus in male and broad ligament and ovarian veins in female) and anorectal venous system, it is reasonable to expect common symptoms such as pain, burning sensation, pruritis, swelling, which arise directly from the involved tissue itself. High coexistence rate of PVV, varicocele/PCS and HD between each other underlines not only the same vascular wall abnormality as an underlying etiology but also the existence of common symptoms originating from the involved tissue in dilating venous disease. Accordingly, it might be reasonable to query the common symptoms of venous dilating disease in other venous vascular regions in patients with complaints of any particular venous territory.

Keywords: Dilating venous disease, chronic venous disorders, peripheral varicose vein, hemorrhoidal disease, varicocele, pelvic varicocities, pelvic congestion syndrome.

Graphical Abstract
Shabani Varaki E, Gargiulo GD, Penkala S, Breen PP. Peripheral vascular disease assessment in the lower limb: A review of current and emerging non-invasive diagnostic methods. Biomed Eng Online 2018; 17(1): 61.
[] [PMID: 29751811]
Rabe E, Pannier F. Clinical, aetiological, anatomical and pathological classification (CEAP): Gold standard and limits. Phlebology 2012; 27(1): 114-8.
[] [PMID: 22312077]
Raffetto JD, Mannello F. Pathophysiology of chronic venous disease. Int Angiol 2014; 33(3): 212-21.
[PMID: 24755829]
Yetkin E, Ileri M. Dilating venous disease: Pathophysiology and a systematic aspect to different vascular territories. Med Hypotheses 2016; 91: 73-6.
[] [PMID: 27142148]
Yetkin E, Ozturk S. Dilating vascular diseases: Pathophysiology and clinical aspects. Int J Vasc Med 2018; 20189024278
[] [PMID: 30225143]
Yetkin E, Ozturk SIM. Varicose vein and ecchymosis: A case report. Int Arch Med 2017; 10.
Ozturk S, Yetkın E. Pelvic venous reflux in male: Varicocele? Phlebology 2018; 33(6): 430-1.
[] [PMID: 29212416]
Atta HM. Varicose veins: Role of mechanotransduction of venous hypertension. Int J Vasc Med 2012; 2012538627
[] [PMID: 22489273]
Mannello F, Ligi D, Canale M, Raffetto JD. Omics profiles in chronic venous ulcer wound fluid: Innovative applications for translational medicine. Expert Rev Mol Diagn 2014; 14(6): 737-62.
[] [PMID: 24918119]
Eklöf B, Rutherford RB, Bergan JJ, et al. American Venous Forum International Ad Hoc Committee for Revision of the CEAP Classification. Revision of the CEAP classification for chronic venous disorders: consensus statement. J Vasc Surg 2004; 40(6): 1248-52.
[] [PMID: 15622385]
Yetkin E. Re: ‘Association of venous disorders with leg symptoms: Results from the bonn vein study 1’. Eur J Vasc Endovasc Surg 2015; 50(6): 828.
[] [PMID: 26460288]
Maurins U, Hoffmann BH, Lösch C, Jöckel KH, Rabe E, Pannier F. Distribution and prevalence of reflux in the superficial and deep venous system in the general population--results from the Bonn Vein Study, Germany. J Vasc Surg 2008; 48(3): 680-7.
[] [PMID: 18586443]
Vinik A, Ullal J, Parson HK, Casellini CM. Diabetic neuropathies: Clinical manifestations and current treatment options. Nat Clin Pract Endocrinol Metab 2006; 2(5): 269-81.
[] [PMID: 16932298]
Mallick R, Raju A, Campbell C, et al. Treatment patterns and outcomes in patients with varicose veins. Am Health Drug Benefits 2016; 9(8): 455-65.
[PMID: 28465773]
Yetkin E, Ileri M, Waltenberger J. Ecchymosis: A novel sign in patients with varicose veins. Clin Hemorheol Microcirc 2018; 68(4): 413-9.
[] [PMID: 29660929]
Yetkin E. Images in Vascular Medicine. A new or overlooked finding of varicose veins: Ecchymosis. Vasc Med 2016; 21(1): 75-6.
[] [PMID: 26443802]
Blättler W, Blättler IK. Relief of obstructive pelvic venous symptoms with endoluminal stenting. J Vasc Surg 1999; 29(3): 484-8.
[] [PMID: 10069913]
Duque MI, Yosipovitch G, Chan YH, Smith R, Levy P. Itch, pain, and burning sensation are common symptoms in mild to moderate chronic venous insufficiency with an impact on quality of life. J Am Acad Dermatol 2005; 53(3): 504-8.
[] [PMID: 16112363]
Raffetto JD, Khalil RA. Matrix metalloproteinases in venous tissue remodeling and varicose vein formation. Curr Vasc Pharmacol 2008; 6(3): 158-72.
[] [PMID: 18673156]
Michiels C, Arnould T, Knott I, Dieu M, Remacle J. Stimulation of prostaglandin synthesis by human endothelial cells exposed to hypoxia. Am J Physiol 1993; 264(4 Pt 1): C866-74.
[] [PMID: 8476019]
Michiels C, Arnould T, Remacle J. Hypoxia-induced activation of endothelial cells as a possible cause of venous diseases: Hypothesis. Angiology 1993; 44(8): 639-46.
[] [PMID: 8342881]
Danziger N. Pathophysiology of pain in venous disease. J Mal Vasc 2007; 32(1): 1-7.
[] [PMID: 17276643]
Vital A, Carles D, Serise JM, Boisseau MR. Evidence for unmyelinated C fibres and inflammatory cells in human varicose saphenous vein. Int J Angiol 2010; 19(2): e73-7.
[] [PMID: 22477593]
Arndt JO, Klement W. Pain evoked by polymodal stimulation of hand veins in humans. J Physiol 1991; 440: 467-78.
[] [PMID: 1804973]
Kakkos SK, Zolota VG, Peristeropoulou P, Apostolopoulou A, Geroukalos G, Tsolakis IA. Increased mast cell infiltration in familial varicose veins: Pathogenetic implications? Int Angiol 2003; 22(1): 43-9.
[PMID: 12771855]
Wittens C, Davies AH, Bækgaard N, et al. Esvs guidelines committee. Editor’s choice - management of chronic venous disease: clinical practice guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg 2015; 49(6): 678-737.
[] [PMID: 25920631]
Khilnani NM, Min RJ. Imaging of venous insufficiency. Semin Intervent Radiol 2005; 22(3): 178-84.
[] [PMID: 21326691]
Bradbury A, Evans CJ, Allan P, Lee AJ, Ruckley CV, Fowkes FG. The relationship between lower limb symptoms and superficial and deep venous reflux on duplex ultrasonography: The Edinburgh Vein Study. J Vasc Surg 2000; 32(5): 921-31.
[] [PMID: 11054224]
Meissner MH. Lower extremity venous anatomy. Semin Intervent Radiol 2005; 22(3): 147-56.
[] [PMID: 21326687]
Lane TRA, Varatharajan L, Fiorentino F, et al. Truncal varicose vein diameter and patient-reported outcome measures. Br J Surg 2017; 104(12): 1648-55.
[] [PMID: 28766692]
Radhakrishnan N, George D, Jayakrishnan R, Sumi S, Kartha CC. Vein size and disease severity in chronic venous diseases. Int J Angiol 2018; 27(4): 185-9.
[] [PMID: 30410288]
Ozturk S, Çuğlan B, Turhan H, Yetkin E. Comment on “vein size and Disease severity in chronic venous disease” by Radhakrishnan et al.: Afflicted vein diameter or signs and symptoms in chronic venous disease: Which one really matters? Int J Angiol 2019; 28(4): 272-3.
[] [PMID: 31790087]
Nicolaides A, Kakkos S, Baekgaard N, et al. Management of chronic venous disorders of the lower limbs. Guidelines According to Scientific Evidence. Part I. Int Angiol 2018; 37(3): 181-254.
[PMID: 29871479]
Racette S, Sauvageau A. Unusual sudden death: Two case reports of hemorrhage by rupture of varicose veins. Am J Forensic Med Pathol 2005; 26(3): 294-6.
[] [PMID: 16121090]
Chang SL, Huang YL, Lee MC, et al. Association of varicose veins with incident venous thromboembolism and peripheral artery disease. JAMA 2018; 319(8): 807-17.
[] [PMID: 29486040]
Hodgson TJ, Reed MW, Peck RJ, Hemingway AP. Case report: The ultrasound and Doppler appearances of pelvic varices. Clin Radiol 1991; 44(3): 208-9.
[] [PMID: 1914405]
Giacchetto C, Cotroneo GB, Marincolo F, Cammisuli F, Caruso G, Catizone F. Ovarian varicocele: Ultrasonic and phlebographic evaluation. J Clin Ultrasound 1990; 18(7): 551-5.
[] [PMID: 2170453]
Ahlberg NE, Bartley O, Chidekel N. Right and left gonadal veins. An anatomical and statistical study. Acta Radiol Diagn (Stockh) 1966; 4(6): 593-601.
[] [PMID: 5929114]
Holdstock JM, Dos Santos SJ, Harrison CC, Price BA, Whiteley MS. Haemorrhoids are associated with internal iliac vein reflux in up to one-third of women presenting with varicose veins associated with pelvic vein reflux. Phlebology 2015; 30(2): 133-9.
[] [PMID: 24755923]
Desimpelaere JH, Seynaeve PC, Hagers YM, Appel BJ, Mortelmans LL. Pelvic congestion syndrome: Demonstration and diagnosis by helical CT. Abdom Imaging 1999; 24(1): 100-2.
[] [PMID: 9933685]
Gültaşli NZ, Kurt A, Ipek A, et al. The relation between pelvic varicose veins, chronic pelvic pain and lower extremity venous insufficiency in women. Diagn Interv Radiol 2006; 12(1): 34-8.
[PMID: 16538582]
Gavrilov SG. Vulvar varicosities: Diagnosis, treatment, and prevention. Int J Womens Health 2017; 9: 463-75.
[] [PMID: 28721102]
Brown KR, Rossi PJ. Superficial venous disease. Surg Clin North Am 2013; 93(4): 963-82. ix-x.[ix-x.].
[] [PMID: 23885940]
Osman MW, Nikolopoulos I, Jayaprakasan K, Raine-Fenning N. Pelvic congestion syndrome. Obstet Gynaecol 2013; 15: 151-7.
O’Brien MT, Gillespie DL. Diagnosis and treatment of the pelvic congestion syndrome. J Vasc Surg Venous Lymphat Disord 2015; 3(1): 96-106.
[] [PMID: 26993690]
Simsek M, Burak F, Taskin O. Effects of micronized purified flavonoid fraction (Daflon) on pelvic pain in women with laparoscopically diagnosed pelvic congestion syndrome: A randomized crossover trial. Clin Exp Obstet Gynecol 2007; 34(2): 96-8.
[PMID: 17629162]
Beard RW, Reginald PW, Wadsworth J. Clinical features of women with chronic lower abdominal pain and pelvic congestion. Br J Obstet Gynaecol 1988; 95(2): 153-61.
[] [PMID: 3349005]
Pyra K, Woźniak S, Drelich-Zbroja A, Wolski A, Jargiełło T. Evaluation of effectiveness of embolization in pelvic congestion syndrome with the new vascular occlusion device (ArtVentive EOS™): Preliminary results. Cardiovasc Intervent Radiol 2016; 39(8): 1122-7.
[] [PMID: 27250353]
Johanson JF, Sonnenberg A. The prevalence of hemorrhoids and chronic constipation. An epidemiologic study. Gastroenterology 1990; 98(2): 380-6.
[] [PMID: 2295392]
Mazier WP. Hemorrhoids, fissures, and pruritus ani. Surg Clin North Am 1994; 74(6): 1277-92.
[] [PMID: 7985064]
Pfenninger JL. Modern treatments for internal haemorrhoids. BMJ 1997; 314(7089): 1211-2.
[] [PMID: 9154017]
Gazet JC, Redding W, Rickett JW. The prevalence of haemorrhoids. A preliminary survey. Proc R Soc Med 1970; 63(Suppl.): 78-80.
[PMID: 5525514]
Madoff RD. Pharmacologic therapy for anal fissure. N Engl J Med 1998; 338(4): 257-9.
[] [PMID: 9435334]
Lockhart-Mummery HE. Non-venereal lesions of the anal region. Br J Vener Dis 1963; 39: 15-7.
[PMID: 13931201]
Loder PB, Kamm MA, Nicholls RJ, Phillips RK. Haemorrhoids: Pathology, pathophysiology and aetiology. Br J Surg 1994; 81(7): 946-54.
[] [PMID: 7922085]
Soares MB, Pitombo MB, Paulo FL, et al. Partial stapled hemorrhoidopexy: Clinical aspects and impact on anorectal physiology. Rev Col Bras Cir 2017; 44(3): 278-83.
[] [PMID: 28767804]
Zagriadskiĭ EA, Bogomazov AM, Golovko EB. Conservative treatment of hemorrhoids: Results of an observational multicenter study. Adv Ther 2018; 35(11): 1979-92.
[] [PMID: 30276625]
Sun Z, Migaly J. Review of hemorrhoid disease: Presentation and management. Clin Colon Rectal Surg 2016; 29(1): 22-9.
[] [PMID: 26929748]
Aslan R, Erbin A, Celik S, et al. Evaluation of hemorrhoidal disease and lower extremity venous insufficiency in primary adult varicocele: A prospective controlled study. Phlebology 2019; 34(9): 621-6.
[] [PMID: 30836835]
Yetkin E. Hemorrhoid, internal iliac vein reflux and peripheral varicose vein: Affecting each other or affected vessels? Phlebology 2015; 30(2): 145.
[] [PMID: 25527517]
Kilciler G, Sancaktutar AA, Avcı A, Kilciler M, Kaya E, Dayanc M. Chronic constipation: Facilitator factor for development of varicocele. World J Gastroenterol 2011; 17(21): 2641-5.
[] [PMID: 21677833]
Godeberge P, Sheikh P, Zagriadskiĭ E, et al. Hemorrhoidal disease and chronic venous insufficiency: Concomitance or coincidence; results of the CHORUS study (Chronic venous and HemORrhoidal diseases evalUation and Scientific research). J Gastroenterol Hepatol 2019.
[] [PMID: 31512275]
Lohsiriwat V. Hemorrhoidal disease Anorectal disorders. Elsevier 2019; pp. 51-63.
Greenfield SP, Seville P, Wan J. Experience with varicoceles in children and young adults. J Urol 2002; 168(4 Pt 2): 1684-8.
[] [PMID: 12352334]
Lomboy JR, Coward RM. The varicocele: Clinical presentation, evaluation, and surgical management. Semin Intervent Radiol 2016; 33(3): 163-9.
[] [PMID: 27582602]
Nagler HM aCDZ.. Varicocele: Current concepts and treatment.Infertility in the male. St. Louis: Mosby 1991; pp. 313- 36
Clarke BG. Incidence of varicocele in normal men and among men of different ages. JAMA 1966; 198(10): 1121-2.
[] [PMID: 5953394]
J. H. The varicocele: A survey amongst secondary school boys. Med Off 1960; 104: 377.
Yetkin E, Kilic S, Acikgoz N, et al. Increased prevalence of varicocele in patients with coronary artery ectasia. Coron Artery Dis 2005; 16(5): 261-4.
[] [PMID: 16000882]
Kiliç S, Aksoy Y, Sincer I, Oğuz F, Erdil N, Yetkin E. Cardiovascular evaluation of young patients with varicocele. Fertil Steril 2007; 88(2): 369-73.
[] [PMID: 17307174]
Oztekin U, Turan Y, Selmi V. The association between high-grade varicocele and endothelial dysfunction. Andrologia 2019; 51(11)e13424
[] [PMID: 31595537]
Sakamoto H, Ogawa Y. Is varicocele associated with underlying venous abnormalities? Varicocele and the prostatic venous plexus. J Urol 2008; 180(4): 1427-31.
[] [PMID: 18710746]
Khera M, Lipshultz LI. Evolving approach to the varicocele. Urol Clin North Am 2008; 35(2): 183. -189 viii. [viii.].
[] [PMID: 18423239]
Erkek E, Basar MM, Bagci Y, Karaduman A, Bilen CY, Gokoz A. Fordyce angiokeratomas as clues to local venous hypertension. Arch Dermatol 2005; 141(10): 1325-6.
[PMID: 16230581]
Schiller PI, Itin PH. Angiokeratomas: An update. Dermatology (Basel) 1996; 193(4): 275-82.
[] [PMID: 8993949]
Robinson SS, Tasker S. Angiomas of the scrotum (angiokeratoma, Fordyce); compilation of cases and discussion of nomenclature. Arch Derm Syphilol 1946; 54(6): 667-74.
[] [PMID: 20277301]
Taniguchi S, Inoue A, Hamada T. Angiokeratoma of Fordyce: A cause of scrotal bleeding. Br J Urol 1994; 73(5): 589-90.
[] [PMID: 8012789]
Rappaport I, Shiffman MA. Multiple phlebectasia involving jejunum, oral cavity, and scrotum. JAMA 1963; 185: 437-40.
[] [PMID: 13973122]
Ozturk S, Akbaba KT, Kılıc S, et al. Venous leg symptoms in patients with varicocele: A multicenter assessment study (VEIN-TURKEY study). Phlebology 2019; 34(2): 128-36.
[] [PMID: 29793400]
Paick S, Choi WS. Varicocele and testicular pain: A review. World J Mens Health 2019; 37(1): 4-11.
[] [PMID: 29774668]
Amelar RD, Dubin L. Therapeutic implications of left, right, and bilateral varicocelectomy. Urology 1987; 30(1): 53-9.
[] [PMID: 3603911]
Zavattaro M, Ceruti C, Motta G, et al. Treating varicocele in 2018: current knowledge and treatment options. J Endocrinol Invest 2018; 41(12): 1365-75.
[] [PMID: 30284221]
Armagan A, Dogan F, Oksay T, et al. The effect of micronized purified flavonoid fraction on the prevention of testicular pathologies in adolescent rats with experimentally induced varicocele. J Urol 2012; 188(5): 2007-13.
[] [PMID: 22999548]
Kiliç S, Güneş A, Ipek D, et al. Effects of micronised purified flavonoid fraction on pain, spermiogram and scrotal color Doppler parameters in patients with painful varicocele. Urol Int 2005; 74(2): 173-9.
[] [PMID: 15756071]
Alonso-Coello P, Zhou Q, Martinez-Zapata MJ, et al. Meta-analysis of flavonoids for the treatment of haemorrhoids. Br J Surg 2006; 93(8): 909-20.
[] [PMID: 16736537]
Yetkin E. Complexity of venous symptoms. Phlebology 2016; 31(2): 147.
[] [PMID: 25700552]
Ozturk S, Yetkin E. Varicose vein or non-varicose vein: That is the question. Eur J Vasc Endovasc Surg 2016; 51(6): 883.
[] [PMID: 27049865]
Dzieciuchowicz Ł, Krzyżański R, Kruszyna Ł, Krasinski Z, Gabriel M, Oszkinis G. Prevalence of non-thrombotic iliac vein lesions in patients with unilateral primary varicose veins. Eur J Vasc Endovasc Surg 2016; 51(3): 429-33.
[] [PMID: 26739803]

Rights & Permissions Print Cite
© 2024 Bentham Science Publishers | Privacy Policy