Metalloproteinase expression in venous aneurysms

Inhibiting MMP13 Attenuates Deep Vein Thrombosis in a Mouse Model by Reducing the Expression of Pdpn

OBJECTIVE

Matrix metalloproteinase 13 (MMP13) is an extracellular matrix protease that affects the progression of atherosclerotic plaques and arterial thrombi by degrading collagens, modifying protein structures and regulating inflammatory responses, but its role in deep vein thrombosis (DVT) has not been determined. The purpose of this study was to investigate the potential effects of MMP13 and MMP13-related genes on the formation of DVT.

METHODS

We altered the expression level of MMP13 in vivo and conducted a transcriptome study to examine the expression and relationship between MMP13 and MMP13-related genes in a mouse model of DVT. After screening genes possibly related to MMP13 in DVT mice, the expression levels of candidate genes in human umbilical vein endothelial cells (HUVECs) and the venous wall were evaluated. The effect of MMP13 on platelet aggregation in HUVECs was investigated in vitro.

RESULTS

Among the differentially expressed genes, interleukin 1 beta, podoplanin (Pdpn), and factor VIII von Willebrand factor (F8VWF) were selected for analysis in mice. When MMP13 was inhibited, the expression level of PDPN decreased significantly in vitro. In HUVECs, overexpression of MMP13 led to an increase in the expression level of PDPN and induced platelet aggregation, while transfection of PDPN-siRNA weakened the ability of MMP13 to increase platelet aggregation.

CONCLUSIONS

Inhibiting the expression of MMP13 could reduce the burden of DVT in mice. The mechanism involves downregulating the expression of Pdpn through MMP13, which could provide a novel gene target for DVT diagnosis and treatment.

Acute Thrombosis of an Aneurysm of the Small Saphenous Vein: A Case Report

BACKGROUND

A venous aneurysm (VA) is a focal dilatation of a nonvariceal vein (diameter increased by at least 1.5 times compared to the adjacent upstream or downstream venous segment), which carries a risk of venous thromboembolism (VTE) when located in the deep veins of the lower limbs but also when it affects the veins above the muscle fascia.

CASE

We report the case of a 40-year-old woman who presented with a painful and disabling mass-like lesion of the upper third of the right calf. A Doppler ultrasound (DUS) examination revealed a small saphenous vein (SSV) dilated at the saphenopopliteal junction (SPJ) and thrombosed along its entire length. Anticoagulant treatment was initiated but although the thrombosis regressed on DUS, the functional impotence and the persistence of pain prompted a stripping of the SSV. Histology allowed the diagnosis of SSV's primary aneurysm.

DISCUSSION

Dilated segments of the saphenous vein are not always varicose veins (VVs). True VAs can develop on veins located above the muscular fascia and, like deep VAs, may trigger VTE. Small saphenous vein aneurysms have seldom been reported, and only a few clinical observations have described the thrombosis of a SSV aneurysm. Any mass in the popliteal fossa or upper part of the calf should be examined by DUS to look for an SSV aneurysm. Excision of the saphenous vein with junctional ligation is advised if thrombosis is present at the time of diagnosis.

Microwave Imaging System Based on Signal Analysis in a Planar Environment for Detection of Abdominal Aortic Aneurysms

A proof-of-concept of a microwave imaging system for the fast detection of abdominal aortic aneurysms is shown. This experimental technology seeks to overcome the factors hampering the fast screening for these aneurysms with the usual equipment, such as high cost, long-time operation or hazardous exposure to chemical substances. The hardware system is composed of 16 twin antennas mastered by a microcontroller through a switching network, which connects the antennas to the measurement instrument for sequential measurement. The software system is run by a computer, mastering the whole system, automatizing the measurement process and running the signal processing and medical image generation algorithms. Two image generation algorithms are tested: Delay-and-Sum (DAS) and Improved Delay-and-Sum (IDAS). Own-modified versions of these algorithms adapted to the requirements of our system are proposed. The system is carefully calibrated and fine-tuned with known objects placed at known distances. An experimental proof-of-concept is shown with a human torso phantom, including an aorta phantom and an aneurysm phantom placed in different positions. The results show good imaging capabilities with the potential for detecting and locating possible abdominal aortic aneurysms and reporting acceptable errors.

Rapidly Growing and Ruptured Great Saphenous Vein Aneurysm in a Liver Transplant Patient

Venous aneurysms are rare vascular malformations that can lead to significant clinical complications, including thrombosis, pulmonary embolism, rupture, and even fatal outcomes when not promptly and adequately managed. This case report presents a liver transplant patient under immunosuppressive therapy who developed a rapidly progressing great saphenous vein aneurysm, ultimately requiring urgent surgical intervention due to acute bleeding from the ruptured aneurysm. Immunosuppression emerges as a potential key factor in the formation and rapid growth of the aneurysm, with the pathophysiological mechanism potentially involving increased expression of specific matrix metalloproteinases. Further research is warranted to gain a better understanding of the role of immunosuppression in the development of venous aneurysms.

Small saphenous vein aneurysm diagnosis and treatment

Venous aneurysms are rare, particularly those arising from the superficial venous system. Current limited evidence suggests that congenital weakness of the vein wall, degenerative changes, trauma and inflammation are among potential causes. Surgical management has been the mainstay treatment modality of venous aneurysms. Surgical approaches and techniques should be tailored on a case-by-case basis, taking into consideration aneurysm location, size, shape and presence of complications (ie, rupture or thrombosis). In this report, we present a male patient in his late thirties who presented with right leg swelling and achiness 2 years following right lower extremity blunt trauma and was found to have a 3 cm small saphenous vein aneurysm extending to the saphenopopliteal junction. The patient was successfully treated with excision of the aneurysm via a posterior approach. This case report adds to the current literature and may help to define future treatment recommendations.

A Popliteal Vein Aneurysm Accompanied by Lower Persistent Sciatic Vein

Popliteal venous aneurysms (PVAs) are rare. Surgical treatment is recommended because of the risk of deep vein thrombosis and fatal pulmonary embolism. A persistent sciatic vein (PSV) is also a rare anomaly. We report a case of a PVA accompanied by a lower PSV. A 70-year-old man was admitted due to left leg heaviness. He had undergone ablation of both great saphenous veins 6 years prior to the admission. Duplex ultrasound showed a PVA on his left leg, which was 3.2 × 2.4 cm in size. The patient was treated with tangential aneurysmectomy with lateral venorrhaphy. His symptom gradually resolved. He received warfarin at a therapeutic range for 3 months. Duplex ultrasound at 6 months later showed no evidence of any recurrent aneurysm or venous reflux. His follow-up has revealed no complications for 18 months. Surgical treatment and perioperative therapeutic anticoagulation are recommended for treating PVAs. Tangential aneurysmectomy with venorrhaphy is the most common and the simplest surgical method.

Subarachnoid haemorrhage in pregnancy after in vitro fertilisation with egg donation: a case report and review of the literature

We report a rare case of in vitro fertilisation (IVF) with egg donation complicated by a subarachnoid haemorrhage (SAH). Haemostatic changes related to IVF are known to increase risk of venous thrombosis; however, less is known regarding the risk of arterial events such as cerebrovascular accidents (CVA). Matrix metalloprotease-9 (MMP-9) upregulated in IVF patients may have a role in arterial aneurysm formation, which is the most common cause of SAH. Further research is required to assess the benefit of screening for risk of CVA and the best way to manage this in the IVF population. This may have implications for the ethics of offering certain procedures such as egg donation to women with pre-existing risk factors.

Azygos Vein Aneurysm Mimicking a Mediastinal Mass

BACKGROUND/AIM

Azygos vein aneurysm (AVA) is a rare thoracic pathological entity that mimics a posterior mediastinal mass as well as a right paratracheal mass. Usually asymptomatic, AVA is often accidentally discovered during routine chest x-rays; however, depending on the aneurysm size and complications, some symptoms may be present. The aim of this paper is to report a case of idiopathic AVA and to discuss its aetiology, embryonic origin, symptoms, complications, diagnostic methods and treatments.

CASE REPORT

A 74-year-old female was investigated for diffuse thoracic pain and submitted to standard chest x-ray, which identified a right paratracheal, well-defined, homogenous opacity, considered to be part of the mediastinal shadow. The patient was further submitted to thoracic computed tomography, which confirmed the presence of a tumoral mass at the level of the right paratracheal area. The patient was submitted to surgery and the tumoral mass was resected; however, the tumor proved to be a completely thrombosed aneurism of the azygos vein arch.

CONCLUSION

AVA is a rare pathology that must be taken into consideration during the differential diagnosis of right postero-superior mediastinal masses.

Pathogenesis and management of superficial venous aneurysms through a case of thrombosed large great saphenous vein aneurysm

INTRODUCTION

Superficial venous aneurysms are uncommon entities though venous Doppler has facilitated the detection of asymptomatic small aneurysms. Thromboembolic complications are rare with superficial venous aneurysms. The data regarding optimal therapy and pathogenesis of superficial venous aneurysm is sparse and is limited to isolated case reports.

METHODS

Here, we present an unusual case of thrombosed large great saphenous vein aneurysm which was managed with Doppler, preoperative anticoagulation and surgical excision.

RESULTS AND CONCLUSION

This paper is intended to review the current knowledge about the pathogenesis of superficial venous aneurysm of lower extremities, their optimal management and to guide future research in this area.

Internal jugular venous aneurysm-A report of two cases with literature review

Internal jugular venous aneurysm (IJVA) is a rare entity that usually remains asymptomatic with only rare complications. We report two cases of IJVA. Both patients presented with a palpable soft tissue mass in the neck and were found to have IJVA on imaging with associated lymphadenopathy. In both cases, the aneurysms and involved lymph nodes were resected, with the jugular vein being primarily reconstructed. There are only a few case reports involving IJVA, and treatment guidelines are not well established. Whereas nonoperative management is frequently chosen, the most common indication for surgery is cosmetic; both management options have favorable outcomes.

Intense remodeling of extracellular matrix within the varicose vein: the role of gelatinases and vascular endothelial growth factor

BACKGROUND

Increased blood pressure in the varicose veins (VV) can contribute to the overexpression of matrix metalloproteinases (MMPs), affecting the endothelium, smooth muscle, and extracellular matrix of the vein wall. Gelatinases (MMP-2 and MMP-9), hypoxia, and inflammation occurring in the VV wall contribute to the increased expression of vascular endothelial growth factor (VEGF).

AIMS

Our objective was to analyze the concentration of gelatinases and VEGF in the great saphenous VV wall and plasma of patients.

METHODS

In total, 65 patients (2nd degree according to clinical state classification, etiology, anatomy, and pathophysiology-CEAP classification) aged 22 to 70 were enrolled. Control veins (n = 10) were collected from the patients who underwent coronary artery bypass graft surgery. Control plasma (n = 20) was obtained from healthy individuals. Gelatinases and VEGF levels were measured with the usage of ELISA method.

RESULTS

A significant increase in MMP-9 (11.2 vs. 9.98 ng/mg of protein) and VEGF (41.06 vs. 26 ng/g of protein) concentration in VV wall compared with control veins was observed. A positive correlation between VEGF versus MMP-2 (p = 0.03, r = 0.27) was found in the VV wall. However, no correlation was found between the concentration of VEGF and MMP-9 (p = 0.4, r = 0.11) in the VV wall. In addition, no statistical differences between MMP-9, MMP-2, and VEGF levels in plasma of VV patients compared with controls were noticed.

CONCLUSIONS

The results of the present study confirm that VV's patients have altered expression of MMPs and VEGF. Overexpression of MMP-9 and VEGF in the VV wall may contribute to the spreading of inflammatory process and suggests the intense remodeling of extracellular tissue within the VV wall.

Primary axillary venous aneurysm in a young patient presenting with cardiac arrest

Primary venous aneurysms are rare and usually asymptomatic. Venous aneurysms are manifested more frequently in the lower extremities than in the upper extremities. Primary venous aneurysms of the upper extremities are more often reported as aesthetically displeasing bulges or incidental findings. Here, we report the rare case of an axillary primary venous aneurysm in a pediatric patient who presented with syncope and massive pulmonary embolism and highlight the management.

Disequilibrium in MMPs and the tissue inhibitor of metalloproteinases in different segments of the varicose great saphenous vein wall

BACKGROUND

Varicose great saphenous veins (VGSVs) are a common disorder with a high incidence, but the pathogenesis is unclear. This study was designed to measure the changes in matrix metalloproteinases (MMPs) and the tissue inhibitor of metalloproteinases (TIMPs) in different segments from VGSV walls to determine the relationship between MMPs, TIMPs expression, and expansion of the venous wall.

METHODS

Twenty-one VGSV and 12 normal great saphenous vein (GSV) specimens were collected. Venous walls in the two groups, expression of MMP-2, MMP-9, TIMP-1, and TIMP-2 proteins, protein-positive expression ratios, mRNA expression, and protein content were determined by immunohistochemistry, PCR, and western blot.

RESULTS

The MMP-2, MMP-9, TIMP-1, and TIMP-2 protein-positive expression ratios, mRNA expression in the upper, middle, and lower segments in the VGSV group were significantly higher than the corresponding regions in the GSV group, respectively. The MMP-2, MMP-9, TIMP-1, and TIMP-2 protein-positive expression ratios, mRNA expression, and protein concentrations in the lower segments in the VGSV group were also significantly higher than the upper and middle segments in the VGSV group and the corresponding regions in the GSV group, respectively.

CONCLUSIONS

Under high hemodynamics, disequilibrium of MMPs and TIMPs from VGSVs exists within the upper, middle, and lower segments of VGSVs. These results suggested that MMPs and TIMPs participate in the process of venous wall remodeling and may be one of the mechanisms associated with the formation and development in varicose veins.

Popliteal Venous Aneurysm Presenting With Bilateral Pulmonary Thromboembolism

A 12-year-old boy presenting with chest pain and dyspnea was found to have bilateral pulmonary thromboembolism (PTE) secondary to left popliteal venous aneurysm (PVA) with thrombus. He improved with thrombolytics, developed recurrent PTE, then underwent surgical repair of his PVA. The pathophysiology, diagnosis, and management of PVA are discussed.

Giant Spontaneous Greater Saphenous Vein Aneurysm

Venous aneurysm, a rare venous anomaly, poses increased risk of distal thromboembolic event. Superficial venous aneurysm, such as greater saphenous vein aneurysm, is an uncommon subset with nonspecific symptoms and often a delay in diagnosis. Symptomatic patients or patients with a thromboembolic event may benefit from surgical intervention with low morbidity. This case report describes an isolated spontaneous greater saphenous vein aneurysm which was successfully ligated and resected for symptomatic relief and prevention of distal thromboembolism.

Primary Axillary Venous Aneurysm Associated with Local Neurological Complications

Primary axillary venous aneurysms (VAs) are rare, and there are only a handful of cases reported previously. The patient can be either asymptomatic or symptomatic and can present with local axillary swelling, dilated venules in overlying skin associated with local discomfort, peripheral neuropathy, or pulmonary embolisms. A 30-year-old man presented with a 4-month history of an uncomfortable lump in his left armpit that was associated with paresthesia radiating down to his left forearm and hand. He had no history of arm swelling and had a normal motor neurological examination. The clinical examination revealed a nontender palpable mass within the left axilla. Venous duplex imaging confirmed the diagnosis of axillary vein aneurysm measuring 6.1 cm. He underwent elective aneurysmorrhaphy repair of the axillary/basilic VA with satisfactory outcome. We present a rare case of a symptomatic primary axillary VA that was managed surgically with complete resolution of symptoms.

A failure of preoperative duplex imaging to diagnose a lower extremity venous aneurysm in a patient with severe chronic venous insufficiency

OBJECTIVE

We present a case of recurrent bilateral lower extremity venous stasis ulcers in association with a superficial venous aneurysm at the right saphenofemoral junction that was misdiagnosed on preoperative duplex scanning.

METHODS

A 53-year-old female presented to our clinic with 6-year history of bilateral lower extremity venous stasis ulcers. Her past medical history was significant for refractory venous stasis ulcers of the bilateral lower extremities present for 6 years and morbid obesity.

RESULTS

Preoperative venous duplex demonstrated severe venous insufficiency of the superficial and deep systems, but a venous aneurysm was not appreciated. During the high ligation of the right saphenofemoral junction, a 3 × 4 × 5 cm aneurysm was encountered. Repair consisted of aneurysm resection, high ligation of the greater saphenous vein, dissociation of the great saphenous and anterior saphenous veins, and stab phlebectomy of large varicose veins of the thigh and lower leg. The patient recovered uneventfully and experienced complete healing of the venous stasis ulcer in several weeks.

CONCLUSION

Superficial venous aneurysms of the lower extremity are rare and can be often missed on preoperative duplex ultrasound imaging. Large diameter measurements of the proximal greater saphenous vein and obesity increase the risk of misdiagnosing venous aneurysms with duplex imaging; therefore, clinical suspicion must remain high. These aneurysms can be associated with significant symptoms for which repair is indicated.

Treatment of upper extremity venous aneurysms with a polytetrafluoroethylene-covered stent

Background Venous aneurysms of the upper torso are uncommon in contrast to the abdomen and lower extremities. Mostly silent, they can cause significant morbidity. Large or symptomatic venous aneurysms are generally treated with open resection. To our knowledge, there are no documented cases of head and neck venous aneurysms treated by a hybrid endovascular and open approach. Case Presentation A 56-year-old female presented with the complaint of pain and increasing size of a supraclavicular mass. Imaging revealed a large saccular aneurysm of the subclavian vein with the presence of a large intramural thrombus on computed tomography scan with contrast. A covered stent was deployed in order to exclude the aneurysm from circulation. Three weeks later, the symptoms continued, and an aneurysmorrhaphy was performed to excise the stent and aneurysm resection. Discussion A combined endovascular and open approach to resection of symptomatic subclavian vein aneurysms is a viable method with minimal morbidity.

Surgical repair of a popliteal vein aneurysm to prevent thromboembolic complications

The case reported here involves a 72-year-old female patient with right-sided popliteal vein aneurysm, which became apparent during follow-up ultrasound scanning after deep venous thrombosis of the left leg with pulmonary embolism. Due to the size of the aneurysm, the decision was made to perform surgery. The aneurysm was tangentially resected by means of plication. Aneurysms of the deep venous system carry a considerable risk of a thromboembolic event and therefore require treatment, even when they are asymptomatic. Surgical treatment of an aneurysm of the deep leg veins is a safe and low-risk procedure for the prevention of pulmonary embolism.

To treat or not to treat basilic vein aneurysms? A clinical dilemma

Superficial venous aneurysms are a very uncommon disease probably associated with thrombosis and recurrent pulmonary thromboembolisms. Surgical treatment is safe and is performed in symptomatic cases. Surgical repair of superficial venous aneurysms is a recommended treatment, and no postoperative complications usually occur. The aim of this study is to report our experience treating superficial venous aneurysms, because they can cause devastating consequences. Obviously, they should be surgically treated if they are symptomatic, but there exists the possibility of complications such as thromboembolic events; however, they are unpredictable. Thus, the only solution to remove the potential risk of developing pulmonary or other embolic events is prophylactic surgery and anticoagulant therapy, also in low-risk patients.

Operative interventions for extrahepatic portomesenteric venous aneurysms and long-term outcomes

BACKGROUND

Extrahepatic portal venous aneurysms (PVAs) are rare, and the pathogenesis is not fully understood. The optimum management of these patients is unknown.

METHODS

Consecutive patients with PVA were identified over an 18-year period (1992-2010). A retrospective review was conducted. Clinical presentation, modality of diagnosis, surgical treatment, 30-day morbidity and mortality, and follow-up are reported.

RESULTS

Four patients were identified who underwent surgical management of an extrahepatic PVA. Operative technique using left renal vein, femoral vein panel graft, polytetrafluoroethylene (ePTFE) graft, and segmental aneurysm wall resected with aneurysmorrhaphy is described. Early complications occurred in 1 patient with an ePTFE graft. The patient returned to the operating room for bleeding. In addition, the same patient had a late graft thrombosis 6 years postoperatively when the anticoagulation was discontinued for pregnancy. The remainder of the patients recovered without complication, and their repairs are still patent with a mean follow-up of 78 months (17-144 months). There were no mortalities in the series.

CONCLUSIONS

Operative intervention for portomesenteric venous aneurysm can be done safely in select patients and should be considered in those with symptoms, rapid growth, mural thrombus, or aneurysms ≥4 cm in diameter. Repair with an autogenous interposition graft affords good long-term patency. Aneurysmorrhaphy may be performed if the remaining venous wall is of good quality.

Great saphenous vein aneurysm presenting as an inguinal hernia

A primary aneurysm in the saphenous vein is very rare. This case study is based on a 55-year-old male patient who applied for general surgery with a complaint of swelling in his left inguinal area, after examinations led to a provisional diagnosis of inguinal hernia. It was decided that surgery was the best option due to the risk of thromboembolism, and pain caused by the condition itself. Confusion with inguinal hernia can affect prognosis. It increases the risk of thromboembolism as well as preventing the chance of early response.

Pulmonary embolism due to popliteal vein aneurysm during pregnancy induced by in vitro fertilization

Popliteal vein aneurysms (PVAs) are rare but may cause severe and even fatal complications, such as pulmonary embolism (PE). A woman at the eighth week of pregnancy came to our attention because of a thrombosis of a previously undetected left PVA, diagnosed after a PE episode. Surgery was delayed until after delivery and breastfeeding, during which anticoagulant therapy was established.

Popliteal venous aneurysm as a cause of recurrent pulmonary embolism

We report 2 cases of recurrent pulmonary embolism (PE) in popliteal venous aneurysm (PVA). Patients were 78-year-old and 72-year-old women. Both were initially seen for acute PE. Saccular and fusiform PVAs were diagnosed in each patient based on duplex ultrasound. However, despite anticoagulation therapy, both patients had PE. At the time of the event, 1 patient was receiving inadequate dose of low-molecular-weight heparin. The other patient was treated with warfarin and had adequate international normalized ratio at the time of re-embolism, and thus, an inferior vena cava filter was inserted. Both patients underwent successful aneurysm resection without any additional thromboembolic events.

Unusual localization of a primary superficial venous aneurysm: a case report

OBJECTIVES

Primary aneurysms of superficial venous system are rare and frequently misdiagnosed as varicose veins. Clinical presentation is variable depending on the presence of compression to surrounding structures. We report a rare case of primary cephalic vein aneurysm presented with wrist pain due to radial nerve compression.

METHOD/CASE

A 61-year-old woman was admitted with right wrist pain and localized mass. Physical and imaging examinations showed a localized cephalic vein aneurysm compressing radial nerve. Simple excision was performed successfully.

RESULTS

Cosmetic and clinical results at the first month follow-up were successful.

DISCUSSION

Although primary superficial venous aneurysms of upper extremities are very rare, the treatment of choice is most commonly same as the ones in lower limbs. Simple excision is the best approach in the most of the cases, while sclerotherapy could be preferred in order to obtain better cosmesis or to avoid injuries to surrounding structures.

Management of symptomatic venous aneurysm

Venous aneurysms (VAs) have been described in quite of all the major veins. They represent uncommon events but often life-threatening because of pulmonary or paradoxical embolism. We describe our twelve patients' series with acute pulmonary emboli due to venous aneurysm thrombosis. Our experience underlines the importance of a multilevel case-by-case approach and the immediate venous lower limbs duplex scan evaluation in pulmonary embolism events. Our data confirm that anticoagulant alone is not effective in preventing pulmonary embolism. We believe that all the VAs of the deep venous system of the extremities should be treated with surgery as well as symptomatic superficial venous aneurysm. A simple excision can significantly improve symptoms and prevent pulmonary embolism.

Postthrombotic vein wall remodeling: preliminary observations

BACKGROUND

Postthrombotic syndrome is characterized by a fibrotic vein injury following deep vein thrombosis (DVT). We sought to quantify the change in vein wall thickness in patients who fail to resolve DVT by 6 months and whether there were differences in blood or plasma levels of inflammatory proteins associated with venous remodeling.

METHODS

Patients presenting with confirmed lower extremity DVT were prospectively recruited for this study. Duplex imaging of the lower extremity venous system was performed, and blood was collected at entrance and repeat evaluation with blood draw and ultrasound imaging at 1 and 6 months. DVT resolution and thickness of the vein wall was quantified by ultrasound imaging in each segment affected by thrombus, and a contralateral, unaffected vein wall served as a control. Gene and protein expression of inflammatory markers were examined from leukocytes and serum, respectively. Analysis of variance or Student t-tests were used, and a P < .05 was significant. N = 10 to 12 for all analyses.

RESULTS

Thirty-two patients (12 patients with DVT resolution at 6 months, 10 patients with persistent thrombus at 6 months, and 10 healthy controls) were compared. Both resolving and nonresolving DVT were associated with a 1.5- to 1.8-fold increased vein wall thickness at 6 months (P = .008) as compared with nonaffected vein wall segments. However, the thickness of the affected segments was 1.4-fold greater in patients who had total resolution of the DVT by 6 months than in patients who had persistent chronic thrombus 6 months after presentation (P = .01). There was a four- to five-fold increased level of matrix metalloproteinase-9 (MMP-9) antigen in thrombosed patients compared with nonthrombosed patient controls (P < .05), while Toll-like receptor-9 (TLR-9) gene expression was three-fold less than controls (P < .05) at enrollment. D-dimer and P-selectin were higher in thrombosed as compared to controls at diagnosis but not at 6 months. Both TLR-4 (marker of inflammation) and P-selectin gene expression were higher in leukocytes from patients with chronic DVT compared with those who resolved at 1 month after diagnosis (P < .05).

CONCLUSIONS

This preliminary study suggests ongoing vein wall remodeling after DVT, measurable by ultrasound and associated with certain biomarkers. At 6 months, the vein wall is markedly thickened and directly correlates with resolution. This suggests that the vein wall response is initiated early following thrombus formation and persists even in the presence of total resolution.

Lesser saphenous vein aneurysm and popliteal vein aneurysm: report of two cases and review of the literature

BACKGROUND

During the last ten years we diagnosed two cases of venous aneurysm. The purpose of this report was to point out a certain risk of the thrombembolism of superficial venous aneurysms and to review our experience in the management of superficial and deep venous aneurysms.

METHODS

The presentation and management of these lesions were reviewed and discussed together with other cases from available literature.

RESULTS

In the first case an aneurysm of lesser saphenous vein with a possible threat of thrombembolism was revealed and surgically solved with saphena resection. Ten years after the surgery she is still symptom free. In the second case a small fusiforme popliteal vein aneurysm without any evidence of mural thrombus was diagnosed. The patient was treated conservatively with regular venous duplex imaging follow up. Two years later the disease has been stable.

CONCLUSIONS

Superficial venous aneurysms can have a certain risk of the thrombembolism. Since surgical therapy is very simple, it can be recommended in all cases. Nevertheless, trombembolism is more common in deep venous aneurysms, especially popliteal ones, in which surgical repair can be based on their pathological features and presentation or can be indicated in all cases.

Salsalate may have broad utility in the prevention and treatment of vascular disorders and the metabolic syndrome

In the high proportion of vascular disorders associated with excessive oxidative stress and production of pro-inflammatory cytokines, activation of NF-kappaB plays a key pathogenic role. Thus, there is considerable evidence that NF-kappaB is a mediator of atherogenesis, plaque destabilization, ischemia-reperfusion damage, cardiac remodeling, atrial fibrillation, and aneurysm formation and rupture; some studies suggest that it may also play a role in the microvascular complications of diabetes. I kappaB kinase-beta (IKK beta) is the upstream kinase that appears to be primarily responsible for NF-kappaB activation in these disorders; moreover, chronic IKK beta activation plays a prominent role in induction of insulin resistance in the metabolic syndrome. Salicylate inhibits IKK beta in concentrations that are achievable with dose schedules traditionally used in treating rheumatoid arthritis (3-4.5 g daily); indeed, this is likely to be the mechanism responsible for salicylate's utility in this disorder. Salicylate, unlike aspirin, is only a very weak, reversible inhibitor of cyclooxygenase in clinical doses, and thus is not associated with the potentially dangerous side effects seen with NSAIDs; fully reversible ototoxicity, the dose-limiting side effect in salicylate therapy, can be avoided in most patients by dosage adjustment. Hence, it is proposed that salicylate may have practical utility in the prevention or management of a wide range of vascular disorders as well as of metabolic syndrome and diabetes; its efficacy in these regards would likely be complemented by effective antioxidant measures, which would lessen the stimulus to NF-kappaB activation while providing benefits independent of NF-kappaB activity. Salsalate, consisting of two salicylate molecules united by an ester bond, is a venerable drug that may be the best tolerated delivery vehicle for salicylate. Appropriate rodent studies should pave the way for clinical trials with salsalate in patients at vascular risk.

Review of Current Theories for Abdominal Aortic Aneurysm Pathogenesis

Atherosclerotic plaques are a feature of abdominal aortic aneurysms (AAAs). Atherosclerosis and AAA appear to share similar risk factors. These observations have led to the conclusion that AAAs are a consequence of advanced atherosclerosis.

This review explores current theories regarding the pathogenesis of AAA and their implications for treatment.

A systematic literature search was conducted using the search terms abdominal aortic aneurysm, atherosclerosis, pathogenesis, and systemic disease. Articles were categorized according to the association of AAAs with atherosclerosis, arteriomegaly, peripheral aneurysm, systemic expression, genetics, autoimmunity, oxidative stress, and systemic disease. Twenty-nine articles reporting changes in the systemic vasculature associated with AAA and 12 articles examining the shared risk factor hypothesis were identified.

There is insufficient evidence to confirm that AAAs are the result of advanced atherosclerosis. The bulk of evidence points to AAA disease being a systemic disease of the vasculature, with a predetermined genetic susceptibility leading to a phenotype governed by environmental factors.