Effect of Surgical Intervention on Proteolytic Activity of Blood in Chronic Venous Disease of the Lower Extremities

DOI: https://doi.org/10.63181/ujcvs.2025.33(4).106-112
Keywords: CVD, chronic venous insufficiency, matrix metalloproteinases, tissue inhibitors of metalloproteinases, surgical treatment, endovenous ablation, MMP-2, TIMP-4

Abstract

Background. Chronic venous disease (CVD) with chronic venous insufficiency (CVI) involves disruption of the proteolytic balance in the venous wall driven by an imbalance between matrix metalloproteinases (MMPs) and tissue inhibitors (TIMPs), particularly MMP-2 and TIMP-4.

Aim. To assess changes in MMP-2, TIMP-4 and their ratio before and after surgical treatment of CVD and to compare the effectiveness of different surgical techniques.

Materials and Methods. A total of 139 patients with chronic venous disease (CEAP C3–C6), aged 18–75 years, were enrolled and allocated into three groups based on the extent of surgical intervention performed. All participants underwent standard clinical assessment and duplex ultrasound. Serum MMP-2 and TIMP-4 concentrations were measured before and after treatment using validated ELISA assays under identical laboratory conditions. Thirty age-matched healthy volunteers served as the control group.

Results. Before treatment, patients showed elevated MMP-2 and reduced TIMP-4 compared with controls. Combined intervention (RFA + miniphlebectomy + perforator ligation) resulted in the most significant decrease in MMP-2, increase in TIMP-4 and near-normalisation of their ratio. Less pronounced but significant changes occurred in subgroup 2A, whereas subgroup 2B and the RFA-only group retained an abnormal MMP-2/TIMP-4 ratio.

Conclusions. Combined surgical treatment most effectively restores proteolytic balance in CVD. Dynamic assessment of MMP-2, TIMP-4 and their ratio may serve as a laboratory indicator of treatment efficiency.

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Published
2025-12-25
How to Cite
1.
Druzhkin MV, Klymenko AV. Effect of Surgical Intervention on Proteolytic Activity of Blood in Chronic Venous Disease of the Lower Extremities. ujcvs [Internet]. 2025Dec.25 [cited 2025Dec.26];33(4):106-12. Available from: http://cvs.org.ua/index.php/ujcvs/article/view/798
Issue
Ukrainian Journal of Cardiovascular Surgery Vol 33 No 4 2025
Section
PATHOLOGY OF THE PERIPHERAL VASCULAR SYSTEM