SaphenionScience: Muscle vein varicosis and intermittend claudicatio disorder – real risk for arteries?
SaphenionScience: Muscle vein varicosis – is there a risk of arterial blood flow? This is very interesting and also for our patients and the vascular and vein specialists a very important question. Because varicose muscle veins are signs of advanced varicose vein disease of the skin veins and the perforator / connecting veins. Important too – muscle veins do not carry venous valves, so they can not defend themselves against the pathologically high pressure of the varicose veins.
SaphenionScience: Muscle vein varicosis: Old phlebographic images showing the varicosis – also varicose muscle vein varicosis were visible.
This advanced varicose vein disease results in heavily dilated muscle veins via a truncal varicose vein and connecting varicose veins. This then constant venous hypertension in all upright positions (even when sitting!). Affects extremely unfavorable to the end stream of the arterial and venous vessels – the arterioles, capillaries, and venules – from. At an advanced stage, it is possible to detect markedly strong microangiopathy of the capillaries. These are greatly expanded and meandered.
From the damaged capillaries, which are supposed to bring the oxygen-rich blood into the muscle via perfusion, large quantities of protein-rich fluid escape into the interstitium. The capillary wall is often permeable to pressure so that complete cellular elements are perfusing (e.g., red blood cells). These are degraded to visible brown hemosiderin deposits in the tissue.
SaphenionScience: Muscle vein varicosis – oxygen pressure as low as the heavy smoker’s leg
In clinical studies of severe venous insufficiency, oxygen pressures were measured that were as deep as in a heavy smoker’s leg (syn: intermittent claudication).
In extreme cases, it can lead to severe skin changes up to the open leg (ulcera crures). Also, load – dependent pain of the calf muscles, a limited performance during physical exercise and a fast and tiring for a long time muscle can be felt (competitive sports!).
Thus, it is an urgent need, in the search for varicose veins by duplex sonography also represents the muscle veins and to weight accordingly functional. As venous specialists, we must also inform the patient of this, as there are no purely cosmetic symptoms or signs of swelling in the summer months.
SaphenionScience: Muscle vein varicosis – clinical examination and therapy
The first item is the question of anamnesis and pain. The clinical examination usually leads to the detection of a defective perforator/ communicating veins. Now, however, it is also important to examine, present and evaluate the most endangered venous valveless muscle veins. This is very well possible today with duplex ultrasound, whereas it was not always possible to represent it reliably in venography (venous radiography with contrast medium).
If there are dilated and varicose muscle veins, we must assume a peripheral capillary – also arterial – circulatory disorder and communicate this to the patient.
There is a significantly increased risk of the already mentioned complications – including a load restriction of the lower leg muscles. However, this is also a significant component in professional active and competitive sports.
A fairly rapid rehabilitation of the truncal varicose veins, lateral veins but also the connecting veins is quite urgent. To what extent the varicose muscle veins are also accessible to direct therapy should be feasible with the newly established non-invasive varicose vein therapy using ultrasound beams (Sonovein therapy).
SaphenionScience: Muscle vein varicosis – Ultrasound lower leg with dilatet muscle veins (right picture). After Sealing Foam, foam is floating also inside the dilated muscle veins (left picture)
SaphenionScience: Muscle vein varicosis: Thrombosis prophylaxis in microfoam therapy?
Is thrombosis prophylaxis in the case of microfoam therapy indicated on the lower leg? In our more than 14000 duplex ultrasound-guided microfoam treatments, we were also able to show a filling or outflow of microfoam via the muscle veins on the lower leg in very many cases.
Therefore, SAPHENION uses foam foaming on the lower leg and side branch/truncal/perforant varicosis to prevent the risk of muscle vein thrombosis under Intra therapeutic thrombosis prophylaxis.
Photos: Utzius
Pathologisches Museum Charitè
Siegenthaler: Pathophysiologie
Weber, May: Funktionelle Phlebologie
Literature / Links:
Siegenthaler, W.: Klinische Pathophysiologie; Georg Thieme Verlag Stuttgart New York 1987.
Weber, J. und May R.: Funktionelle Phlebologie; Georg THieme Verlag Stuttgart, New York, 1990.
Danneil,O.; C.Kern und M.Stücker: Tiefe Muskelvenenthrombose nach Sklerosierung eines Seitenastes unter laufender Therapie mit Tamoxifen; vasomed 5, 2019.