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Near Infrared Fluorescence Imaging to Demonstrate Reflux in the Superficial Microvenous Network of the Leg

      Objective

      Reflux within the superficial microvenous network may play a critical role in the development of skin changes which can be associated with chronic venous insufficiency. This study aimed to determine if near infrared fluorescence (NIRF) imaging could be used to accurately determine superficial venous reflux in the leg.

      Methods

      A total of nine limbs were examined ex vivo from patients undergoing limb amputation for peripheral arterial disease. Cannulation of the distal great saphenous vein was used to sequentially perform Xray contrast enhanced venography, NIRF imaging, and venous corrosion casts.

      Results

      Fluorescence imaging visualised a range of different microvenous reflux patterns ex vivo, which were generally not evident by Xray venography but were consistent with retrograde resin vascular casts. These included both focal and diffuse regions of fluorescence within the skin and, consistent with previous observations, the vascular casts indicated that regions of venous reflux were typically associated with incompetent valves.

      Conclusion

      The findings from this study suggest a potential method for investigating early stage superficial venous disease, prior to the appearance of visible signs of advanced venous disease, such as skin changes. However, further studies are required to confirm the in vivo clinical utility of these observations.

      Keywords

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      References

        • Evans C.J.
        • Fowkes F.G.
        • Ruckley C.V.
        • Lee A.J.
        Prevalence of varicose veins and chronic venous insufficiency in men and women in the general population: Edinburgh Vein Study.
        J Epidemiol Community Health. 1999; 53: 149-153
        • Onida S.
        • Davies A.H.
        Predicted burden of venous disease.
        Phlebology. 2016; 31: 74-79
        • Rabe E.
        • Pannier F.
        Societal costs of chronic venous disease in CEAP C4, C5, C6 disease.
        Phlebology. 2010; 25: 64-67
        • Vincent J.R.
        • Jones G.T.
        • Hill G.B.
        • van Rij A.M.
        Failure of microvenous valves in small superficial veins is a key to the skin changes of venous insufficiency.
        J Vasc Surg. 2011; 54 (62S–69S)
        • Eklof B.
        • Perrin M.
        • Delis K.T.
        • Rutherford R.B.
        • Gloviczki P.
        • American Venous F.
        • et al.
        Updated terminology of chronic venous disorders: the VEIN-TERM transatlantic interdisciplinary consensus document.
        J Vasc Surg. 2009; 49: 498-501
        • Samies J.H.
        • Gehling M.
        • Serena T.E.
        • Yaakov R.A.
        Use of a fluorescence angiography system in assessment of lower extremity ulcers in patients with peripheral arterial disease: a review and a look forward.
        Semin Vasc Surg. 2015; 28: 190-194
        • Lurie F.
        • Passman M.
        • Meisner M.
        • Dalsing M.
        • Masuda E.
        • Welch H.
        • et al.
        The 2020 update of the CEAP classification system and reporting standards.
        J Vasc Surg Venous Lymphat Disord. 2020; 8: 342-352
        • Bernardini E.
        • De Rango P.
        • Piccioli R.
        • Bisacci C.
        • Pagliuca V.
        • Genovese G.
        • et al.
        Development of primary superficial venous insufficiency: the ascending theory. Observational and hemodynamic data from a 9-year experience.
        Ann Vasc Surg. 2010; 24: 709-720
        • Labropoulos N.
        • Giannoukas A.D.
        • Delis K.
        • Mansour M.A.
        • Kang S.S.
        • Nicolaides A.N.
        • et al.
        Where does venous reflux start?.
        J Vasc Surg. 1997; 26: 736-742
        • Eberhardt R.T.
        • Raffetto J.D.
        Chronic venous insufficiency.
        Circulation. 2014; 130: 333-346
        • De Maeseneer M.G.
        • Kakkos S.K.
        • Aherne T.
        • Baekgaard N.
        • Black S.
        • Blomgren L.
        • et al.
        European Society for Vascular Surgery (ESVS) 2022 clinical practice guidelines on the management of chronic venous disease of the lower limbs.
        Eur J Vasc Endovasc Surg. 2022; 63: 184-267
        • Labropoulos N.
        • Tiongson J.
        • Pryor L.
        • Tassiopoulos A.K.
        • Kang S.S.
        • Mansour M.A.
        • et al.
        Definition of venous reflux in lower-extremity veins.
        J Vasc Surg. 2003; 38: 793-798
        • Govind D.
        • Thomas K.N.
        • Hill B.G.
        • van Rij A.M.
        Microvenous Reflux in the Skin of Limbs with Superficial Venous Incompetence.
        Ultrasound Med Biol. 2018; 44: 756-761
        • Ortega-Santana F.
        • Hernandez-Morera P.
        • Ruano-Ferrer F.
        • Ortega-Centol A.
        infrared illumination and subcutaneous venous network: can it be of help for the study of CEAP C1 limbs?.
        Eur J Vasc Endovasc Surg. 2020; 59: 625-634
        • Mordon S.
        • Devoisselle J.M.
        • Soulie-Begu S.
        • Desmettre T.
        Indocyanine green: physicochemical factors affecting its fluorescence in vivo.
        Microvasc Res. 1998; 55: 146-152

      Linked Article

      • In Chronic Venous Disease Micro is Probably Bigger than Macro!
        European Journal of Vascular and Endovascular SurgeryVol. 64Issue 4
        • Preview
          The microcirculation constitutes 99% of the circulation in our bodies. It is the most important part of the circulation as it is the exchange surface for nutrients, O2, and CO2, and without it there is no life. In patients with chronic venous disease (CVD), the development of signs and symptoms are also dependent on the state of microcirculation. Multiple studies have used different techniques and histological findings from biopsies to demonstrate microvascular alterations. The work on microvenous reflux in the current paper demonstrates, in a detailed manner, its importance in CVD.
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