Wall Structure and Composition Changes of Varicose Veins of the Legs: A Ultrastructural Study

Son, Hyo Sung; Oh, Chang Keun; Kim, Moon Bum; Lee, Jae Bong; Jang, Ho Sun; Kwon, Kyung Sool

Abstract

BACKGROUND
Over the years many possible explanations for the development of varicose vein have been suggested. The main possible mechanisms are a valvular failure theory and a weak wall theory. However, the definite cause of varicose has not been determined yet. OBJECTIVE: The aims of this study are to observe the pathologic changes in the smooth muscle cells and extracellular matrix of the primary varicose vein. An understanding of the pathology may possibly help to understand the pathogenesis of varicose veins. METHODS: A total of 20 vein specimens of primary varicose vein were collected from 13 patients who underwent ambulatory phlebectomy. Among them, 16 specimens were thick segments and 4 specimens were thin segments of varicose veins. Control samples were collected from two patients with no history and clinical evidence of varicose vein. Each specimen was examined with a JEM 1200EX-II electron microscopy. Ultrastructural findings between thick and thin segments of varicose veins and normal veins were also compared semiquantitatively. RESULTS: The smooth muscle cells of varicose veins were abnormal in shape and lost their fusiform appearance with many vacuoles. Increased extracellular matrix shows the increase of degenerated collagen fibers and decrease of elastic fibers. Thin segments revealed more atrophic smooth muscle cells and phagocytosis than thickened segments. Thick segments showed increased collagen fiber. CONCLUSION: These ultrastructural changes may be not the primary cause of varicose veins but the secondary remodeling processes of vein walls by hemodynamic stress.