Smooth muscle changes in varicose veins: an ultrastructural study.

In order to understand the pathology of varicose veins, we prospectively collected a total of 23 vein specimens both from the normal proximal thigh long saphenous vein (LSV) in 3 young trauma patients and from the unstripped proximal LSV near the sapheno-femoral junction and the distal calf blowouts in 10 primary varicose veins patients. Ultra-thin sections were examined under the transmission electron microscope (TEM). Compared with the normal control LSV, varicose vein sections showed increase in the diameter of the lumen, hypertrophy of the wall and elongation and invagination of the intima. Smooth muscle cells (SMCS) lost their normal fusiform shape and were widely separated by increased amounts of extra-cellular collagen fibers. The cells underwent marked degeneration, vacuolization and disintegration into fiber-like material and small separated fragments. SMCs were seen in the subintimal tissue and some of them were lost into tile lumen. SMCs also showed marked phagocytic activity, engulfing not only collagen and elastic fibers, but also other smooth muscle cells. Although these changes were more marked and advanced in the distal calf blowouts, they were also present in the proximal, clinically non-dilated LSV. In conclusion, SMCs of varicose veins show severe degeneration in both the distal calf blowouts and the proximal, clinically non-varicose LSV. It appears that they both form and phagocytose collagen and elastic fibers and play a major role in the pathogenesis of varicose veins.

Ultrastructural changes in a case of mucoid degeneration of the brachial artery.

An electron microscopic (EM) description of mucoid degeneration of the brachial artery in a 67 year old man is presented. In this case, the affected artery showed mucoid degeneration of the intima and media circumferentially, dissecting and destroying the muscle fibres. Ultrastructurally, mucoid degenerating muscle cells showed numerous large mucin-containing vesicles in the cytoplasm. Cells were widely separated by large accumulation of mucoid material, which appeared to penetrate the extracellular collagen fibre bundles. Most of the nuclei of the smooth muscle cells displayed typical necrotic changes undergoing dissolution or having already broken up into discrete fragments. This case of intimo-medial degeneration (IMMD) suggests that the condition could arise spontaneously anywhere in the inner coats of the arterial system away from the vessels that are close to synovial joints. This is a rare presentation of IMMD of arteries, which has been described mainly in the aorta and its major branches.

Changes of elastic and collagen fibers in varicose veins.

BACKGROUND: The resistance to stretch and the elasticity of the vein wall depend on the collagen and elastic fibers, respectively. Contradicting evidence exists, however, on the connective tissue concentration in varicose veins. METHODS: A prospective, comparative study was conducted at Asir Central Hospital and the College of Medicine in Abha, Saudi Arabia. Twenty-three vein specimens collected from both the proximal thigh long saphenous vein (LSV) and the distal calf blowouts in 10 primary varicose vein patients and from the normal, proximal thigh LSV in 3 young vascular trauma patients were examined. Paraffin sections stained with hematoxylin and eosin, Verhoeff von Gieson (VVG) and Masson's Trichrome stains were examined under the light microscope. Ultra thin sections were examined under the transmission electron microscope (TEM). RESULTS: Compared with the normal control LSV, varicose vein sections showed increased diameter of the lumen and hypertrophy of the wall, mainly of the intima, due to increased amounts of collagen fibers. This marked fibrous infiltration disrupted the normal palisade arrangement of the intimal and the regular sheet-like arrangement of the medial smooth muscle cells. Collagen fibers also lost their normal pattern and showed abnormal forms. Elastic fibers lost their regular laminar arrangement and formed clumps or scattered fragments. CONCLUSIONS: Varicose veins showed increased collagenosis and distortion of the elastic fibers. The presence of abnormal collagen to elastin ratio and the loss of the regular collagen/elastic lattice of the vein wall may play a major role in the pathogenesis of varicose veins.

Histopathological changes in the wall of varicose veins.

AIM: Vein wall distensibility is controlled by collagen, elastin and smooth muscle cells. However, contradicting evidence exists on the connective tissue concentration and smooth muscle pathology in varicose veins. METHODS: To study the pathological changes in the wall of varicose veins at different levels, we collected a total of 49 vein specimens from 19 patients at Asir Central Hospital, Abha, Saudi Arabia, during the period from March to October 1997. Three young trauma patients underwent repair of their arterial injuries using the thigh long saphenous vein (LSV) and 16 varicose vein patients underwent stripping of their LSV and avulsion of their distal calf varicosities. In the trauma patients, specimens were collected from the proximal thigh LSV while in the varicose vein patients, specimens were collected from both the groin and mid-thigh LSV and the distal calf varicosities. Specimens were stained with Hematoxylin & Eosin, Masson's Trichrome and von Gieson (VG) stains for examination under the light microscope. RESULTS: Compared with the normal LSV, all varicose vein sections showed marked intimal hypertrophy due fibrous tissue infiltration, localized thinning of the muscle layer and loss of both the intimal and medial smooth muscle cells (SMCs). Elastic fibers were deficient and scattered with loss of the normal elastin/collagen lattice network and decrease in both the muscle/collagen and elastin/collagen ratios. CONCLUSION: In conclusion, we propose that dilatation and distensibility of the vein wall under normal and increased venous pressure is due to deficiency in smooth muscle cells and elastic fibers and disproportionate increase in fibrous tissue.

Recurrent varicose veins.

Recurrence of varicose veins after treatment has been reported as being between 7% and 65%. During the five month period from August to December 1993, 400 operations on 265 patients were performed for varicose vein disease. Of these, 53 patients had presented with recurrent vein disease in 72 limbs (18%). All patients underwent Duplex scanning of their deep and superficial systems and sites of venous incompetence were identified. The sapheno-femoral junction (SFJ) was found to be incompetent in 52 limbs, of which 31 had previously undergone flush ligation. Sapheno-popliteal junction (SPJ) was incompetent in 33 limbs, while the long saphenous vein (LSV) was found to be incompetent in 67 cases. There were no major complications in this group. Minor complications occurred in 10 cases (14%), mainly in the form of thigh paraesthesia. The more common causes of recurrent disease have been identified and therefore, it should be possible to reduce its incidence. Duplex scanning is essential for any unit dealing with recurrence.

Oxygenation of blood in varicose veins.

The aim of this prospective, controlled study is to compare the oxygen tension of blood from varicose veins with that from both the antecubital vein of the same patients and the normal long saphenous vein of normal controls at high altitude in Abha (8,000 feet above sea level), Saudi Arabia. Forty-two subjects (21 normal controls and 21 with uncomplicated primary varicose veins) had blood samples taken from 41 normal long saphenous veins and 35 varicose veins near the ankle, respectively (a total of 76 lower limbs). Samples were also taken simultaneously from the right antecubital vein in all the subjects. There was no difference in either oxygen tension (pO2) or saturation (sO2) between blood from varicose veins and blood from normal long saphenous veins. However, in patients with varicose veins, both pO2 and sO2 of varicose veins blood were significantly higher than those of arm venous blood (P = 0.009 and P = 0.018, respectively). In normal subjects, blood from normal long saphenous veins had also significantly higher sO2 (P = 0.001) than that from arm veins, but pO2 was not higher. In conclusion, the theory of arteriovenous communication is poorly founded. There must be other more important explanations for the pathogenesis of varicose veins.

Mucoid degeneration of the brachial artery: case report and a review of literature.

Cystic adventitial disease (CAD) is a rare cause of intermittent claudication, occurring in approximately 1:1200 claudicants or 1:1000 of those undergoing arteriography. It is most often described in the popliteal artery and is characterised by a mucinous cyst located in the adventitia of the artery, the contents of which resemble those of a ganglion. The origins of adventitial cysts are unknown, but connections to adjacent synovial spaces have been identified, suggesting that the cyst is a variant of a ganglion. In this report, we discuss a rare case of severe mucoid degeneration of the intima and media in a 67-year-old Saudi male patient. The patient presented with a saccular aneurysm of his right "mid-arm" brachial artery and critical ischemia of his right hand from distal embolisation.

Experimental model of varicocele.

The purpose of this investigation was to create a varicocele model in animals and to study the subsequent alterations in testicular physiology. The study comprised 22 dogs divided into 2 groups: test and control. In the test group (17 dogs), excision of a longitudinal strip of the fasciomuscular tube of the spermatic cord was done on one side only. In the control group (5 dogs), the spermatic cord was exposed without interference with the tube. Testicular temperature was measured, and biopsies from the 2 testicles and semen specimens were examined. Re-examination for variceal changes was performed in 3 dogs at the 4th postoperative week; in 3 dogs at the 6th, and in 16 dogs (11 test and 5 control) at the 8th postoperative week. Sections from spermatic cord and testicle were examined microscopically. Serum levels of testosterone follicle-stimulating hormone, luteinizing hormone and prolactin were assayed preoperatively and at the time of re-examination. Manifest varicocele was detected in 16 of 17 detubated dogs. It was huge in all dogs re-examined after 8 weeks. Semen showed decreased sperm count in all test animals except 1. The animals with induced varicocele had higher testicular temperature than the controls. Microscopically, the detubated spermatic cords have shown variceal changes and the testicle degenerative changes in all the test animals. Similar changes were encountered in the contralateral testicle in the animals re-examined at 8th week. Radioimmunoassay showed a significant decrease of serum testosterone and increase of prolactin postoperatively. Follicle-stimulating hormone and luteinizing hormone showed no significant change from the preoperative level.(ABSTRACT TRUNCATED AT 250 WORDS)