Key finding

Younger patients with chronic venous insufficiency (CVI) show a myriad of DNA damage with tissue and systemic consequences.

Study summary

In this study, 110 patients with and without CVI and a body mass index of ≤25 kg/m2 were separated into age brackets. Those with reflux underwent saphenectomy and tissue samples were sent for analysis. Gene expression studies, collagen age assessment, and immunohistologic analysis were performed. The results suggest that valve incompetence increases extracellular matrix remodeling manifested by certain gene alterations, with the process significantly more present in younger persons. Several proinflammatory markers were elevated, perhaps indicating aging and cell damage.

Commentary

I am unclear as to the significance of this study. The adage “which comes first, the chicken or the egg?” comes to mind. Do the DNA aberrations lead to the venous reflux or does the reflux lead to the aberrations? How much occurs without reflux over time as a result of the aging process? Is more DNA damage seen in patients with venous ulcerations? Clearly, this study represents one piece of the pathophysiologic puzzle around the development of CVI and its consequences. Obtaining tissue samples from patients is impossible with the advent of endovenous ablation techniques; thus, these questions and repeat studies are challenging, if not impossible, to answer or to perform. Is there a predictive value for these markers and DNA damage or are they nonspecific? Too many questions and directions for future research.

Article InfoPublication HistoryJ Cell Mol Med 2021;25:7878-7889.Identification

DOI: https://doi.org/10.1016/j.jvsv.2022.04.005

Copyright

© 2022 Published by Elsevier Inc.

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