Role of saphenous vein wall in the pathogenesis of primary varicose veins.
Varicose veins may be due to weakness of the vein wall as a result of structural problems. There are conflicting findings in the literature about these problems especially concerning collagen, elastin and smooth muscle cells content. The aim of this study was to look at the structural abnormalities of varicose veins (with and without valvular incompetence).


METHODS
We studied 70 specimens of long saphenous veins from 35 patients (24 with varicose and 11 with normal veins). Two specimens were taken from each vein approximately 3-4 cm from the saphenofemoral junction. Vein specimens were processed for histological and electron microscopic studies. Both qualitative and quantitative analyses were performed to assess the degree of wall changes. Using the image analyzer, contents of collagen, elastin and smooth muscle cells, in addition to intimal and medial thickness, were measured.


RESULTS
Light microscopy revealed significant increase in intimal and medial thickness and collagen content of media and significant decrease in elastin content in varicose veins compared with normal veins. There was no statistical significant difference between varicose veins with and without saphenofemoral valve incompetence. Electron microscopy showed marked degenerative changes in intima and media of varicose veins.


CONCLUSIONS
The findings in our study supported the theory of primary weakness of the vein wall as a cause of varicosity. This weakness is due to intimal changes, disturbance in the connective tissue components and smooth muscle cells.
Elsharawy
Mohamed A
MA
Department of Surgery, College of Medicine, King Faisel University, P. O. Box 40081, Al-Khober, 31952, Eastern Province, Kingdom of Saudi Arabia. elsharawya@yahoo.co.uk
Naim
Magda M
MM
Abdelmaguid
Eiman M
EM
Al-Mulhim
Abdulmohsen A
AA
D000328:Adult; D016022:Case-Control Studies; D003094:Collagen / Q000032:analysis; D004534:Egypt; D004548:Elasticity; D004549:Elastin / Q000032:analysis; D005260:Female; D006801:Humans; D008297:Male; D008854:Microscopy, Electron; D032389:Myocytes, Smooth Muscle / Q000648:ultrastructure; D012501:Saphenous Vein / Q000737:chemistry / Q000503:physiopathology / Q000648:ultrastructure*; D012529:Saudi Arabia; D013194:Staining and Labeling / Q000379:methods; D017539:Tunica Intima / Q000737:chemistry / Q000648:ultrastructure*; D017540:Tunica Media / Q000737:chemistry / Q000648:ultrastructure*; D014648:Varicose Veins / Q000209:etiology / Q000378:metabolism / Q000473:pathology* / Q000503:physiopathology; D014689:Venous Insufficiency / Q000150:complications* / Q000473:pathology
D003094:Collagen; D004549:Elastin