A 40-year-old woman presented with large bulging veins in both thighs and lower legs. Her primary concern was the unsightly aesthetic appearance of the varicose veins but on further questioning, she revealed that she was experiencing heaviness, tiredness and throbbing in the lower legs. She worked as a medical assistant, which involved constant standing for hours, at daily basis. By the end of the day, her legs were extremely fatigued, and it would take several hours of leg elevation to make them feel better. There was no past medical history of deep venous thrombosis. Duplex Ultrasound examination revealed a varicose great saphenous vein bilaterally running from the groin to the mid-distal thigh. Examination of the deep veins of both lower limbs showed no evidence of occlusion in the external iliac, common femoral, popliteal, anterior and posterior tibialis, and peroneal. Which of the following mechanisms is most likely to explain the patient's findings? Group of answer choicesFailure of arteriovenous anastomosesFailure of venous valves in the deep veinsPredominance of smooth muscle cells of a synthetic phenotype in venous wallsMutation of the vascular endothelial growth factor receptor 3 geneDysfunctional endothelium producing increased levels of vasodilatory mediators
Question
A 40-year-old woman presented with large bulging veins in both thighs and lower legs. Her primary concern was the unsightly aesthetic appearance of the varicose veins but on further questioning, she revealed that she was experiencing heaviness, tiredness and throbbing in the lower legs. She worked as a medical assistant, which involved constant standing for hours, at daily basis. By the end of the day, her legs were extremely fatigued, and it would take several hours of leg elevation to make them feel better. There was no past medical history of deep venous thrombosis. Duplex Ultrasound examination revealed a varicose great saphenous vein bilaterally running from the groin to the mid-distal thigh. Examination of the deep veins of both lower limbs showed no evidence of occlusion in the external iliac, common femoral, popliteal, anterior and posterior tibialis, and peroneal. Which of the following mechanisms is most likely to explain the patient's findings? Group of answer choicesFailure of arteriovenous anastomosesFailure of venous valves in the deep veinsPredominance of smooth muscle cells of a synthetic phenotype in venous wallsMutation of the vascular endothelial growth factor receptor 3 geneDysfunctional endothelium producing increased levels of vasodilatory mediators
Solution
The most likely mechanism to explain the patient's findings is the failure of venous valves in the deep veins.
Varicose veins are a common condition characterized by dilated, tortuous veins seen most often in the legs. They are caused by the failure of venous valves, leading to venous stasis and increased venous pressure. This patient's job, which involves prolonged standing, would exacerbate this condition, as standing increases the pressure in the veins of the lower limbs.
The other options are less likely:
- Failure of arteriovenous anastomoses is not typically associated with varicose veins.
- A predominance of smooth muscle cells of a synthetic phenotype in venous walls is more associated with vascular remodeling and not specifically with varicose veins.
- Mutation of the vascular endothelial growth factor receptor 3 gene is associated with lymphatic disorders, not varicose veins.
- Dysfunctional endothelium producing increased levels of vasodilatory mediators is more associated with conditions like septic shock, not varicose veins.
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