Abstract
Vitamin D alleviates oxidative stress in varicose veins: A pilot study in obese and non-obese patients
Rațiu S, Mariş MI, Furdui-Lința AV, Stanciu-Lelcu T, Borza C, Olariu S, Bratu T, Sturza A, Muntean DM. Mol Cell Biochem 2025 Apr 22.
The authors’ aim was to investigate D3 [1,25(OH)2D3], the biologically active form of vitamin D, on oxidative stress in varicose veins obtained from both obese and non-obese patients undergoing cryostripping surgery for varicose vein ablation. Varicose venous samples treated or not with 1,25(OH)2D3 (100 nM, 12-h incubation) were analyzed for reactive oxygen species (ROS) generation using the ferrous xylenol orange oxidation (FOX) assay and immunofluorescence technique. Additionally, the gene expression of endothelial nitric oxide synthase (eNOS), neuronal nitric oxide synthase (nNOS), and inducible nitric oxide synthase (iNOS) were assessed via qPCR. There was a significant reduction in circulating 25-hydroxyvitamin D3 [25(OH)D3] levels in obese as compared to non-obese patients. Ex vivo incubation of the venous samples with 1,25(OH)2D3 resulted in: (i) significant reduction in ROS level, (ii) upregulation of eNOS and nNOS expression, and (iii) downregulation of iNOS expression in both groups of patients. Vitamin D did not exhibit a ROS scavenger effect, and the antioxidant effect is presumably mediated via its receptor whose presence was confirmed in the varicose venous samples.
The authors concluded that vitamin D exerts protective effects in venous pathology, which may be beneficial in acute administration prior to the surgical intervention. Large clinical trials are required to assess the optimal dosage and time/duration of administration in patients with chronic venous disease with surgical indication.
Cold hypersensitivity in the lower extremities: An underappreciated symptom in patients with varicose veins
Tsai CK, Wu HY, Nfor ON, Tantoh DM, Lu WY, Liaw YP. Open Heart. 2025 Apr 15;12(1)
The authors aimed to investigate the frequently overlooked symptoms of cold hypersensitivity and heavy legs related to varicose veins. Data on 8,782 adults aged 30–70 years without a history of cancer were sourced from Taiwan over a 12-year period. There were significant associations between varicose veins, cold hypersensitivity, and heavy legs. Varicose veins, cold hypersensitivity, and heavy leg sensations were assessed using questionnaires on heavy legs (p<0.0001). Logistic regression models showed that moderate and severe cold hypersensitivity increased the risk of varicose veins with ORs of 1.490 (95% CI 1.205 to 1.842) and 1.894 (95% CI 1.546 to 2.320), respectively. Similarly, heavy legs were strongly associated with varicose veins (OR 4.239, 95% CI 3.381 to 5.315), and the interaction between cold hypersensitivity and heavy legs was significant (p=0.0009). Notably, the greatest risk for varicose veins was observed in individuals with heavy legs and severe cold hypersensitivity (OR 7.135, 95% CI 4.980 to 10.221).
The authors concluded that the clinical significance of considering cold hypersensitivity and heavy legs as vital symptoms for diagnosing varicose veins, particularly in the absence of arterial disorders, can improve diagnostic accuracy and patient outcomes.
Retrospective study of hypersensitivity reactions in patients undergoing cyanoacrylate closure of lower extremity superficial veins
Lee J, Png CYM, Mulaney-Topkar B, Waller D, Chandrasekhar V, Stoughton J. J Vasc Surg Venous Lymphat Disord. 2025 Apr 7:102246
The authors aimed to determine the incidence, onset, duration, and severity of hypersensitivity reactions (HSRs) following cyanoacrylate closure (CAC), as well as identify risk factors for the development of HSRs. This study included 122 patients with 193 veins treated between 2018 and 2022. Patients with symptomatic, incompetent superficial lower extremity veins, including the great saphenous vein (GSVs), small saphenous vein, and anterior accessory saphenous vein, were included. Data on patient demographics, clinical history, procedure details, and post-procedural Duplex ultrasound results were collected. The incidence of HSRs was 21.2%. Symptom onset occurred on average 7.6 days post-procedure (SD = 7.4) with most patients experiencing mild (76%) or moderate (24%) symptoms that resolved without intervention, with non-steroidal anti-inflammatory drugs, or with steroid treatment. There was a significantly higher risk of HSRs with younger age (p=0.0372), female sex (p=0.0025), and history of allergies (p=0.0049). Longer veins (0.0205) and GSVs (p = 0.0388) had stronger associations with HSRs.
The authors concluded that HSRs are a potential adverse complication of the CAC procedure, with most cases being self-limited and affecting individuals who are younger, are female, and have a history of allergies.
Calf muscle-venous pump dysfunction in patients with pelvic venous disorder
Gavrilov SG, Karalkin AV, Moskalenko EP, Grishenkova AS. Ann Vasc Surg. 2025 Mar 24:116:61-72.
The authors’ aim was to study the evacuation function of calf muscle-venous pump (CMP) in patients with pelvic venous disorder (PeVD). This single-center cross-sectional study included 170 female patients (120 with PeVD ± chronic venous disease (CVD) and 50 with CVD without PeVD) and 20 healthy volunteers. All subjects underwent duplex ultrasound (DUS) of the pelvic and lower extremity veins, radionuclide venography (RV) of the lower extremities, and single-photon emission computed tomography (SPECT) of the pelvic veins (PVs) with in vivo labeled red blood cells (RBCs). The pelvic venous congestion (PVC) signs were deposition of labeled RBCs in the PVs and the PVC coefficient (CPVC) > 0.5. The CMP evacuation dysfunction was identified during RV as an increase in the average isotope transit time (Tave) in the tendon (Tt) and muscle (Tm) parts of CMP and in the popliteal vein (Tpv). The CMP dysfunction was detected in 81.6% and 78.3% of patients with symptomatic and asymptomatic PeVD, accordingly, and in 92% of patients with CVD. This condition was characterized by a significant increase in the isotope transit time (Tt 18-30 s, Tm 27-45 s, and Tpv 20-40 s).
The authors concluded that the CMP dysfunction is present in about 80% of patients with PeVD, regardless of the clinical course of PeVD and the presence of CVD of the lower extremities.
1291: Bridging the gap: Advancing ultrasound guidance for central venous catheter confirmation in the ICU
Ford T, Mulat E, Rosenzweig T, Ablordeppey E. Critical Care Medicine 53(1): January 2025. DOI: 10.1097/01.ccm.0001103828.63496.36.
In this study, the authors evaluate the implementation of the DRAUP program, which uses ultrasound (US) instead of chest X-ray (CXR) for central venous catheter (CVC) confirmation in the surgical ICU. Despite its proven efficacy in the emergency department, DRAUP adoption in the ICU remained low, with only 20% of eligible cases utilizing it. A significant portion (44%) of attempts failed due to inadequate US views, with increasing body weight being a statistically significant factor (p=0.019) in unsuccessful attempts.
The authors conclude that while US guidance remains widely used for catheter placement, barriers such as imaging challenges in higher BMI patients limit DRAUP’s effectiveness in replacing CXR for CVC confirmation.
Efficacy of ultrasound-guided foam sclerotherapy in the healing of venous leg ulcers
Bishara RA, Gaweesh A, Hanna IN, Allam AK, Moabed MR, Essam S, Taha W, Davies AH , Shalhoub J. J Vasc Surg Venous Lymphat Disord. 2025 Apr 8:102244. doi: 10.1016/j.jvsv.2025.102244. Online ahead of print.
The authors, in this multicenter randomized controlled trial, evaluated the efficacy of ultrasound-guided foam sclerotherapy (UGFS) as an adjunct to standard care in treating venous leg ulcers (VLU). Patients were randomized to receive either standard care alone or standard care plus UGFS targeting the refluxing venous network around the ulcer. The study was stopped early due to clear benefit at interim analysis. Results showed that UGFS significantly reduced ulcer healing time (median 35 vs. 56 days, p=0.008), increased the proportion of ulcers healed within 3 months (97% vs. 75%, p=0.01), and accelerated ulcer size reduction.
The authors concluded that both groups improved in clinical severity scores, but UGFS notably enhanced outcomes, supporting its role as an effective adjunct to standard VLU care.
Three-year outcomes of surgical implantation of a novel bioprosthetic valve for the treatment of deep venous reflux
Cifuentes S, Figueroa AV, Glickman M, Ulloa JH. Ann Vasc Surg. 2025 Apr 17:S0890-5096(25)00246-8. doi: 10.1016/j.avsg.2025.03.036. Online ahead of print.
This first-in-human study evaluated the mid-term outcomes of the VenoValve, a surgically implanted porcine bioprosthetic valve designed to restore deep venous competence in patients with chronic venous insufficiency due to post-thrombotic syndrome (PTS). Eleven patients in Colombia received the valve between 2019 and 2020. At 3-year follow-up, the device showed a 79% primary patency rate, with significant improvements in reflux times (62% reduction), Venous Clinical Severity Score (52% reduction), and pain (84% reduction). Two cases of valve thrombosis occurred after stopping anticoagulation.
The authors concluded that the results demonstrate promising mid-term safety and efficacy, supporting ongoing evaluation in a larger U.S. trial.
Utility of venoactive compounds in post-thrombotic syndrome: A systematic review
Gloviczki ML, Stoughton J, Puggioni A, Gloviczki P, Raffetto JD. J Vasc Surg Venous Lymphat Disord. 2025 Mar 16;13(4):102228. doi: 10.1016/j.jvsv.2025.102228. Online ahead of print.
In this systematic review, the authors assessed the evidence from randomized controlled trials (RCTs) on the use of venoactive compounds (VACs) for preventing and treating post-thrombotic syndrome (PTS). Eleven RCTs using agents like diosmin, MPFF, and sulodexide were included. Although many studies had methodological limitations, findings consistently showed that VACs improved venous symptoms, reduced edema, and promoted ulcer healing. Two recent high-quality studies indicated potential benefits of diosmin and MPFF alongside rivaroxaban for PTS prevention. However, due to outdated or low-quality data, further well-designed RCTs are needed.