Reflux origin of the insufficient small saphenous vein by duplex ultrasound determination and consequences for therapy considering the saphenopopliteal junction type.

OBJECTIVE: The reflux pathophysiology of the saphenofemoral junction (SFJ) of the insufficient great saphenous vein (GSV) has already been investigated and stratified. These results are still lacking for the small saphenous vein (SSV). The aim of the study was to analyze the pathophysiology of the saphenopopliteal junction (SPJ) in case of refluxing SSV. METHODS: The study included 1142 legs investigated between April 1, 2019, and February 15, 2023, with chronic venous insufficiency scheduled for endoluminal thermal ablation of the insufficient SSV. Preoperatively, a standardized duplex ultrasound assessment of the SPJ including the cranial extension of the SSV and the Giacomini vein, respectively, was performed to determine the origin of reflux. Having in mind, that the draining type according to Cavezzi is relevant to the treatment planning, after having scanned 152 legs, the protocol was extended to this feature: Cavezzi type A1 or A2 was recorded on 990 legs. RESULTS: In 984 cases (86%), saphenopopliteal reflux from the popliteal vein into the insufficient SSV was detected, and in 181 cases of these (16%), simultaneous refluxing blood from the cranial extension or Giacomini vein was found. In 119 cases (10%), reflux resulted only from the cranial extension or Giacomini vein with a competent SPJ, and in 39 cases (3%), the reflux source was diffusely from side branches and/or perforating veins. Cavezzi's junction types A1 (independent junction of SSV and muscle veins) and A2 (muscle veins join into SSV, draining together into the popliteal vein through the SPJ) were found in 65% and 35% of cases, respectively. CONCLUSIONS: The insufficient SSV shows a high frequency of axial reflux from the deep into the saphenous vein with an indication for high ligation or thermal ablation at the level of the SPJ or immediately distal to the inflow of muscular veins depending on the junction type. In 14%, based on this study, we observed a competent junction of the SSV without indication for ligation or thermal destruction of the SPJ.

Non-invasive evaluation of dermal elastosis by in vivo multiphoton tomography with autofluorescence lifetime measurements.

The non-invasive differentiation of dermal elastic fibres from solar elastosis in vivo is of great interest in dermatologic research, especially for efficacy testing of anti-ageing products. To date, no studies on multiphoton excited fluorescence lifetime characteristics of human elastic fibres and solar elastosis are reported. The goal of the present work was the identification of differential criteria for elastic fibres and solar elastosis by the analysis of fluorescence decay curves acquired by time-correlated single photon counting in vivo multiphoton tomography. For this purpose, fluorescence lifetime measurements (FLIM) were performed with 47 volunteers of different age groups at sun-protected and sun-exposed localizations. Bi-exponential curve fitting was applied to the FLIM data, and characteristic differences between age groups and localizations were found in both relevant fit parameters describing the decay slope. The FLIM analyses have shown that dermal autofluorescence has different lifetimes depending on age and in part on localization.

Intrinsic, solar and sunbed-induced skin aging measured in vivo by multiphoton laser tomography and biophysical methods.

BACKGROUND: Skin aging is accelerated by extrinsic factors, particularly actinic damage. Over the last decades, both clinical and pathological differences between intrinsic and actinic aging have been characterized. In this work, we aimed at quantifying skin aging by non-invasive in vivo methods. METHODS: Young healthy volunteers using indoor tanning facilities and aged people were compared with appropriate controls by measurements of skin elasticity with the Cutometer and the Reviscometer and by semi-quantitative evaluation of the dermal matrix composition by the multiphoton laser tomograph DermaInspect. RESULTS: We found differences between the sun-protected volar forearm and the dorsal side as well as between young and old test persons with all three methods. No significant differences were found between the skin of indoor-tanned test persons and control. Also, gender had no influence on the severity of skin aging. CONCLUSION: The most consistent results were obtained with the DermaInspect. The considerable inter-individual variation due to the cross-sectional design of the study may have disguised the factual skin damage caused by tanning beds.

Morphological skin ageing criteria by multiphoton laser scanning tomography: non-invasive in vivo scoring of the dermal fibre network.

BACKGROUND: Morphological changes in the dermal collagen and elastin fibre network are characteristic for skin ageing and for pathological skin conditions of the dermis. OBJECTIVES: To characterize pathological and physiological conditions by multiphoton laser scanning tomography (MLT) in vivo, it is necessary to investigate and identify morphological alterations related to ageing. METHODS: In vivo MLT was used to image two-photon excited autofluorescence (AF) and second harmonics generation (SHG) in human dermis of 18 volunteers of different ages. Criteria for the evaluation of age-dependent morphological changes in MLT images were fibre tension and morphology, network pattern, clot formation and image homogeneity. These criteria were weighted and a score was calculated. RESULTS: The resulting MLT-based Dermis Morphology Score is correlated with age (R2 = -0.90) and with the previously published SHG to AF Ageing Index of Dermis (R2 = 0.66). The two groups of young (age 21-38) and old (age 66-84) volunteers showed a significant difference in MLT score values (P < 0.001). CONCLUSIONS: We could demonstrate an in vivo relationship between morphological characteristics of human dermis assessed by MLT and age. The present score allows the semi-quantitative evaluation of specific morphological changes of the dermal fibre network in ageing skin by in vivo AF and SHG imaging. This method will be useful for diagnostics of pathological conditions and their differentiation from ageing effects.