The impact of gastrocnemius muscle cell changes in chronic venous insufficiency.
OBJECTIVE
To investigate the pathological and metabolic changes in the gastrocnemius muscle in patients with chronic vein insufficiency (CVI).


METHODS
Thirty-six patients with varicose veins were investigated by ambulatory venous pressure (AVP) and duplex ultrasonography. Twelve age and height-matched controls were used for comparison. Patients and controls consented to participate in this study. Twenty-one patients with primary vein varicose (group AI) and 15 patients (group AII) with primary deep venous valve incompetence (DVI) underwent biopsies of the gastrocnemius muscle during operation. Adductor biopsies obtained from the same limbs served as a control group (group B) and specimens from controls subjects without venous disease served as the second control group (group C). All the specimens were investigated by superoxide dismutase (SOD), nitric oxide (NO), Na+-K+-ATPase, Ca2+-ATPase and lactic acid (LD) determinations. Samples were subjected to light and electron microscopy following H & E staining, special ATPase, cytochrome oxidase/succinate dehydrogenase (COX/SDH) stains.


RESULTS
Normal muscle architecture was seen following H & E, ATPase and COX/SDH staining and normal cell metabolism was observed in specimens of groups B and C. In group A, pathological changes were encountered in the gastrocnemius muscle including disseminated myofibril atrophy, cell denaturation and necrosis, inflammatory cell infiltration, proliferation and dilation of interfascicular veins. ATPase staining (pH 9.4) demonstrated grouping of atrophic fibres, especially type I myofibril grouping, accompanied by moderate to severe atrophy of type II muscle fibres. However, no patient had selective type I fibre atrophy. Enhanced enzymatic activity in single or multiple myofibrils was demonstrated by COX/SDH staining in approximately half of the specimens in group AII. In group AII, electron microscopy showed swelling, myelin figure denaturation of mitochondria, disruption of the myofibrils and increased lipid droplets in the gastrocnemius muscle. Increased concentration of LD was found in most specimens from group A patients. There were also reductions of SOD, NO, biochemical activity of Na+-K+-ATPase, Ca2+-ATPase with increasing concentration of LD in these patients, most prominently in group AII. We found correlation between AVP assessments and the biochemical measurements as well as morphological appearances of the gastrocnemius muscle.


CONCLUSIONS
Venous hypertension results in pathophysiological changes in the gastrocnemius muscles of patients with DVI, associated with decreased calf pump function.
Qiao
T
T
Department of Vascular Surgery, Drum Tower Hospital, Affiliated Hospital of Medical College, Nanjing University, Nanjing 210008, China. qiaotongmail@yahoo.com.cn
Liu
C
C
Ran
F
F
D000328:Adult; D000368:Aged; D001284:Atrophy; D000252:Calcium-Transporting ATPases / Q000378:metabolism; D016022:Case-Control Studies; D003576:Electron Transport Complex IV / Q000378:metabolism; D005260:Female; D006801:Humans; D019344:Lactic Acid / Q000378:metabolism; D007866:Leg / Q000098:blood supply*; D008297:Male; D008853:Microscopy; D008875:Middle Aged; D018485:Muscle Fibers, Skeletal / Q000378:metabolism / Q000473:pathology; D018482:Muscle, Skeletal / Q000378:metabolism / Q000473:pathology*; D009210:Myofibrils / Q000473:pathology; D009336:Necrosis; D009569:Nitric Oxide / Q000378:metabolism; D000254:Sodium-Potassium-Exchanging ATPase / Q000378:metabolism; D013385:Succinate Dehydrogenase / Q000378:metabolism; D013482:Superoxide Dismutase / Q000378:metabolism; D018616:Ultrasonography, Doppler, Duplex; D014648:Varicose Veins / Q000276:immunology / Q000473:pathology; D014689:Venous Insufficiency / Q000276:immunology / Q000473:pathology*; D014690:Venous Pressure
D009569:Nitric Oxide; D019344:Lactic Acid; D013482:Superoxide Dismutase; D013385:Succinate Dehydrogenase; D003576:Electron Transport Complex IV; D000252:Calcium-Transporting ATPases; D000254:Sodium-Potassium-Exchanging ATPase