title: Changes in the extracellular matrix of the vein wall--the cause of primary varicosis?
abstract: BACKGROUND
  Conflicting theories on the development of primary varicosis have led to the molecular biological investigation of the vein wall or, more accurately, of the extracellular matrix. It was the aim of this study to quantify matrix expression and to compare pathological changes in the vein wall with valve-orientated staging of varicosis, in order to determine indicators of the primary cause of varicosis.
  
  
  METHODS
  Three hundred seventy-two tissue specimens of greater saphenous veins were obtained from 17 patients with varicosities and categorised according to Hach stage and procurement site. The specimens were compared with 36 specimens collected from six patients without varicosities, incubated with fluorescence-stained antibodies for collagen 4, laminin, fibronectin and tenascin prior to being assessed with confocal laser scan microscopy. In addition, 22 vein specimens (16 varicose, 6 normal veins) serving as negative controls were investigated.
  
  
  RESULTS
  Image analysis and statistical evaluation showed that compared with normal veins, varicose veins are associated with a significant increase in matrix protein expression for collagen 4, laminin and tenascin. A trend towards an increase in matrix expression was further observed for fibronectin. There was, however, no difference between varicose veins and clinically healthy vein segments inferior to a varicose segment.
  
  
  CONCLUSIONS
  If the findings of the present investigation can be confirmed by other studies, alterations in the vein wall may be regarded as the primary cause of varicosis and valvular insufficiency as the result of these changes.
authors.affiliation: Department of General and Abdominal Surgery, Johannes Gutenberg-University Hospital, Mainz, Germany. Kirsch@ach.klinik.uni-mainz.de
authors.forename: D
authors.initials: D
authors.lastname: Kirsch
authors.forename: H P
authors.initials: HP
authors.lastname: Dienes
authors.forename: R
authors.initials: R
authors.lastname: Küchle
authors.forename: H
authors.initials: H
authors.lastname: Duschner
authors.forename: W
authors.initials: W
authors.lastname: Wahl
authors.forename: T
authors.initials: T
authors.lastname: Böttger
authors.forename: T
authors.initials: T
authors.lastname: Junginger
mesh_terms: D005109:Extracellular Matrix / Q000473:pathology*; D016326:Extracellular Matrix Proteins / Q000032:analysis; D006801:Humans; D018613:Microscopy, Confocal; D008856:Microscopy, Fluorescence; D012501:Saphenous Vein / Q000473:pathology; D014648:Varicose Veins / Q000473:pathology*; D014689:Venous Insufficiency / Q000473:pathology
chemical_list: D016326:Extracellular Matrix Proteins