Öztürk, Serkan UtkuYetkin, Ertan2021-06-232021-06-2320161078-58841532-2165https://doi.org/10.1016/j.ejvs.2016.02.024https://hdl.handle.net/20.500.12491/8788We read the article published by Dzieciuchowicz et al.1 with great interest. In their study, they assessed the possible association between the presence of a non-thrombotic iliac vein lesion (NIVL) and primary varicose veins (PVV), and the frequency of NIVLs in asymptomatic and PVV limbs. Intra-vascular ultrasonographic evaluation of venous structures including the femoral, external iliac, common iliac vein, and inferior vena cava showed that NIVLs were not more common in limbs with PVV than in limbs without PVV. They also confirmed both the existence and left-sided predomi-nance of anatomical compression of the common iliac vein by the right common iliac artery. Regarding the pathophysiology, significant associations of varicose veins with other dilating vascular diseases, such as varicocele and coronary artery ectasia, have been reported.2,3 These reports raise concerns that PVVs are a local manifes- tation of a systemic vascular abnormality. Therefore, assuming the non-PVV limb to be normal might lead to misinterpretation of the Dzieciuchowicz et al. report. Adding Duplex ultrasonographic results of both limbs would make things clearer for discussion of the pathophysiological aspect of disease. Likewise the authors reported comparable luminal areas of external iliac veins in PVV limb and non-PVV limb.1 We believe that the non-PVV limb might have clinically si-lent venous insufficiency at an earlier stage than the PVV limb. Symptoms of peripheral venous insufficiency are another debate in the clinical evaluation of patients. Although it is not within the scope of the study under discussion here, it would be useful to know which lower limb symptoms were taken into consideration when determining the non-PVV limb as asymptomatic. The presence and severity of varicose veins may not show a particular association with lower limb symptoms and even with duplex ultrasound scanning.4 In conclusion, assessment of “normal vein” and “varicose vein” in the same individual could make it more difficult to improve our understanding of venous disease or varicose veins.eninfo:eu-repo/semantics/openAccessVaricose VeinNon-Varicose VeinNIVLPVVNote10.1016/j.ejvs.2016.02.02451688388327049865WOS:000378441700028Q1