Varicose veins are a common condition affecting millions of people worldwide, with primary varicose veins being the most common type. However, not all primary varicose veins are the same. In a recent study published in CoP Preprints by Mark Steven Whiteley, Antonina Bankowska, Scott J Dos Santos, Henry F Ashpitel, and F. Javier Salguero-Bodes, researchers reported on a new type of primary varicose vein called Primary Avalvular Varicose Anomalies (PAVA).
PAVA occurs in approximately 4.6% of patients with primary varicose veins and can be easily confused with neovascular tissue. Unlike typical varicosities, PAVA can be found in all compartments of the leg and are more commonly found in patients with pelvic venous reflux. Little is known about these atypical vessels, and so researchers conducted a histopathologic analysis of PAVA to better understand its features.
The study involved removing a section of PAVA under ultrasound guidance from a patient undergoing routine endovenous thermoablation for varicose veins, along with several varicosities extracted by phlebectomy. The venous tissue was fixed in buffered formalin and underwent routine histological processing into paraffin wax. Sections were cut 4 microns thick and were stained with haematoxylin and eosin (H&E), Martius Scarlett Blue (MSB), and immunohistochemical staining for smooth muscle actin (SMA). Stained sections were examined by a board-certified pathologist.
The results showed distinct differences between PAVA and “normal” varicose veins. PAVA had multiple protrusions into the lumen of the abnormal vessel, due to an irregularly enlarged media. The media was rich in collagen, and there was a reduction in the smooth muscle cells found circumferentially throughout the media and adventitia. In contrast, varicosities removed by phlebectomy appeared normal, with all three tunicae clearly visible.
While the samples only came from one patient, the study provides an early report of the histological differences between PAVA and “normal” varicose veins. The findings suggest that PAVA may represent a distinct type of primary varicose vein with unique characteristics that require further investigation.
More work is needed to understand the exact derivation of PAVA and to confirm these findings in a larger sample of patients. Nonetheless, the study highlights the importance of recognizing and understanding the different types of primary varicose veins to improve their diagnosis and treatment.