Clinical trial NCT04436549: Pathology, Venous Disease, and Clinical Correlations
Official title: Clinical and Pathological Correlations in Chronic Venous Disease
Study type: OBSERVATIONAL
Overall status: UNKNOWN
Conditions: Varicose Veins
Pathology
Symptoms and Signs
Keywords: pathology
varicose veins
chronic venous disease
symptoms
Lead sponsor: University of Catanzaro
Sponsor class: OTHER
First posted: 2020-06-18
Enrollment: 100
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Observational model: COHORT
Time perspective: CROSS_SECTIONAL
Sampling method: NON_PROBABILITY_SAMPLE
Study population: Patients with varicose veins that are scheduled to undergo surgery for varicose veins removal.

Brief summary: Chronic Venous Disease (CVD) has a high prevalence in the general population of the western world. Varicose veins are the main signs of this disease that are characterized by important pathological vessel wall changes. There are also several symptoms that affect the quality of life of affected patients. The aim of this study is to correlate the main histopathological abnormalities with the type and the intensity of the symptoms.

Detailed description: Chronic Venous Disease (CVD) of the lower limbs is a widespread chronic condition of the western world. There are several signs and symptoms that affect quality of life of patients with CVD. One of the main signs of this disease are varicose veins that are enlarged, swollen, and twisting superficial veins. Vessel wall of varicose veins shows a significant histopathological phenotype, characterized by a distortion of structural architecture: endothelial damage, disorganization of muscle bundles and alteration of the composition of the extracellular matrix (ECM). Symptoms may be different, according to disease state, progression and local inflammatory processes. To date, there is no study that correlate the type and the intensity of symptoms with histopathological phenotype.

Aim of this study is to correlate histopathological phenotype with clinical manifestations.

A cohort of patients with varicose veins scheduled for open surgical treatment that will undergo to stab avulsion of varicose veins will be recruited. Subsequently, venous tissue from stab avulsion will collected in order to evaluate the following biomarkers: VEGF (Vascular -Endothelial Growth Factor), PGP 9.5 (Protein Gene Product 9.5), Fibronectin and Matrix Metalloproteinase- 9 (MMP-9).

VEGF has a key role as a regulator of angiogenesis; its expression is highly regulated by hypoxia, in this case induced by venous hypertension. In addition to being a marker of neoangiogenesis, it increases vascular permeability in inflammatory disorders. PGP 9.5 is a marker of the innervation of the vessel wall that plays an important role in the regulation of venous tone. Fibronectin and MMP-9 are direct markers of ECM remodeling and impairment and they have also a role in chronic inflammation.

Eligibility criteria: Inclusion Criteria:

* Patients with varicose veins scheduled for surgery

Exclusion Criteria:

* Peripheral artery disease
* Malignancy

Primary outcomes:
measure: Expression of Matrix Metalloproteinase-9 (MMP-9)
timeFrame: at 10 month
measure: Expression of Vascular Endothelial Growth Factor (VEGF)
timeFrame: at 10 month
measure: Expression of Fibronectin
timeFrame: at 10 month
measure: Expression of Protein Gene Product 9.5 (PGP 9.5)
timeFrame: at 10 month
Secondary outcomes:
measure: Correlation of the biomarkers expression with signs and symptoms
timeFrame: At 11 month.
Other outcomes:
Locations:
city: Catanzaro
country: Italy
facility: CIFL- Interuniversity Center of Phlebolymphology
city: Catanzaro
country: Italy
facility: University Magna Graecia of Catanzaro
Study officials:
affiliation: University Magna Graecia of Catanzaro
name: Raffaele Serra, M.D., Ph.D.
role: PRINCIPAL_INVESTIGATOR
References:
citation: Birdina J, Pilmane M, Ligers A. The Morphofunctional Changes in the Wall of Varicose Veins. Ann Vasc Surg. 2017 Jul;42:274-284. doi: 10.1016/j.avsg.2016.10.064. Epub 2017 Mar 11.
citation: Kucukguven A, Khalil RA. Matrix metalloproteinases as potential targets in the venous dilation associated with varicose veins. Curr Drug Targets. 2013 Mar;14(3):287-324.
citation: Kolano P, Bednarski IA, Lesiak A, Skibinska M, Stasikowska-Kanicka O, Danilewicz M, Narbutt J. Overexpression of cathepsin K and vascular endothelial growth factor in chronic venous ulcerations. Postepy Dermatol Alergol. 2020 Apr;37(2):234-239. doi: 10.5114/ada.2020.94840. Epub 2020 May 6.