Phlebosclerosis in lower extremities veins - a systematic review

Phlebosclerosis: An overlooked complication of varicose veins that affects clinical outcome: A case report

BACKGROUND

Phlebosclerosis is a common age-related fibrotic degeneration of the venous wall. It is a disorder rather than a disease, which may cause venous dysfunction and even venous thrombosis. It is rarely reported in patients with varicose veins.

CASE SUMMARY

The present report describes the case of a 70-year-old man with varicose veins, vitiligo, and phlebosclerosis. Venous angiography revealed blood reflux in the superficial and deep veins. The patient underwent surgery to remove the saphenous veins. During the operation, a calcified vein resembling a wooden stick was found, which was surprisingly extracted from the thickened venous wall. A cross-section of this wooden stick-like vein revealed venous fibrosis and calcification, obvious thickening of the venous wall, extensive collagen deposition on the venous wall, hyaline degeneration, and venous sclerosis causing closure of the venous lumen.

CONCLUSION

This is probably the first report of a wooden stick-like structure being found in the venous wall in patients with varicose veins and venous ulcers. Phlebosclerosis can be observed in the late stage of varicose veins complicated by frequent infections and worse clinical outcomes. Therefore, it is important to be aware of this condition and address it rather than overlook it.

Anatomical variations of the great saphenous vein at the saphenofemoral junction. A cadaveric study and narrative review of the literature

OBJECTIVES

The great saphenous vein is the lower limb's longest and thickest-walled superficial vein. Its anatomy is complex, while its anatomical variations are widespread. This study aimed to illustrate the anatomy and variations of the great saphenous vein at the saphenofemoral junction.

METHODS

The study was conducted on 75 fresh-frozen cadaveric lower limbs. Cadavers with evidence of prior leg surgery or trauma and any congenital abnormality or gross deformity were excluded. The saphenofemoral junction was studied in detail with emphasis on the number, incidence, draining pattern of tributaries, and duplication of the great saphenous vein.

RESULTS

Out of the 75 cadaveric lower limbs, 57.3% were obtained from males, and 42.7% were obtained from females. The mean age of the cadaveric lower extremities was 66.6 years (range 42-91). The number of tributaries at the saphenofemoral junction varied from 0 to 7, with a mean of 3.8. The most frequent number of branches was 4-5 in 61.3% of cases. The most consistent tributary was the superficial external pudendal vein, while the posterior accessory great saphenous vein was the least frequent tributary. 80% of the branches drained into the saphenofemoral junction directly (53.3%) or by a common trunk (26.7%%). The most frequent common trunk was the superficial epigastric and superficial circumflex iliac vein (10.7%). The rest 20% of the tributaries drained directly into the common femoral vein. The commonest branch reaching the common femoral vein was the superficial external pudendal vein (10.7%). Duplication of the great saphenous vein was observed in 2.7% of the cases.

CONCLUSIONS

There is a significant variation of tributaries at the saphenofemoral junction regarding the number, incidence, draining pattern of branches, and duplication of the great saphenous vein.

Subcutaneous Calcifications in Legs with Chronic Venous Diseases

BACKGROUND

Calcifications in the subcutaneous layer (SCL) have been described by x-rays studies in legs with advanced chronic venous disorders (CVD). However, SCL calcifications are rarely included among the changes CVD-related. The aim of this study was to evaluate the prevalence and morphology of SCL calcifications in legs with CVD of all grades of severity by ultrasonography (US).

MATERIAL AND METHODS

Five hundred legs in 250 patients (148 females and 102 males, mean age 51, range 18-87) referred to the vascular clinic for symptoms and signs of CVD were included. After the Duplex evaluation of deep, superficial, and perforating veins the skin and the SCL were investigated by Duplex sonography. Subjects with other possible cause of SCL calcification were excluded.

RESULTS

According to the CEAP-C classification, 43 legs were classified as C1,189 as C2, 34 as C3, 16 as C4A, 45 as C4B or C, 18 as C5 and finally 16 as C6. Varicose veins were reported in 273 legs, lipodermatosclerosis (LDS) in 79. Subcutaneous calcifications were demonstrated in 35/361 CVD legs in two different locations: in the wall of superficial varicose veins (SVC) or in the subcutaneous tissue unrelated to the path of superficial veins (STC). The SVC were found in 12 out of 273 legs with varicose veins (4.4%). They were found in older patients with severe varicose veins disease (grade 3 of VCSS and disease duration >30 yrs). The STC were found in 24 out of 95 legs in the more advanced CVD stages (C4A-C6 classes). No STC were found in C1, C2, and C3 legs.

DISCUSSION

SVC were found only in legs with severe and long-lasting varicose veins and seem to be related to a chronic severe inflammation of the venous wall. STC are independent from the vein wall and were found only in the damaged areas of legs with severe CVD (C4-C6). They are possibly related to chronic inflammation of the subcutaneous tissue. Their avulsion from the ulcer bed is recommended to facilitate ulcer healing and prevent their recurrence.

Phlebosclerotic colitis in a non-Asian patient: a case report

Background

Phlebosclerotic colitis is a rare condition with a high mortality. It has been seen almost exclusively in Asian patients who are ≥ 60 years old, with a slight male predominance. Although it predominantly affects the right colon and seems to be related in some cases to using natural herbal medicines, neither its etiology nor its pathogenesis are known.

Case presentation

We present an extremely rare case of a 62-year-old Spanish white man patient of non-Asian ethnicity with no history of using natural medications, who was diagnosed with phlebosclerotic colitis of submucosal veins.

Conclusion

To date, this is the only case reported in Spain, and only the second reported for Europe, in the literature. Due to the nonspecific symptoms and insidious radiological findings of this disease (both in early and mild stages) as well as exclusive submucosal involvement presented here, it is necessary that the treating physician has a high level of suspicion for its diagnosis.