title: Evaluation of apoptosis in varicose vein disease complicated by superficial vein thrombosis.
abstract: BACKGROUND
  The factors contributing to superficial vein thrombosis (SVT) in patients with varicose vein disease are unclear. Differences in vein wall apoptotic activity could be associated with the pathogenesis of SVT. The aim of the study is to address the role of the programmed cell death in the vein wall by comparing varicose veins with history of SVT to uncomplicated varicose veins.
  
  
  METHODS
  Vein segments from the proximal part of the great saphenous vein (GSV), the distal part of the vein and from a varicose tributary, from 16 patients with varicose vein disease and one episode of SVT, were evaluated for the immunohistochemical expression of pro-apoptotic (Bax, p53, Caspase 3, BCL-6, BCL-xs), anti-apoptotic (BCL-xl and BCL-2) and proliferation (Ki-67) markers. The results of this study were compared to the results from the evaluation of 19 patients suffering from uncomplicated varicose vein disease and 10 healthy GSVs as controls.
  
  
  RESULTS
  Overall, there was increased apoptosis in the distal part of GSV compared to the proximal part documented by increased expression of Bax (p < 0.01), Caspase 3 (p = 0.01), BCL-xs (p < 0.01). The comparisons of the markers' expression between patients with varicose veins and patients with a history of SVT showed significant differences among the three different anatomic locations. In the proximal GSV, only BCL-xs was higher in patients with SVT (p = 0.029). In the tributaries, Bax, BCL-xl and Ki-67 were higher in patients with SVT (p < 0.01). In the distal GSV, increased Bax, BCL-xs, BCL-xl and Ki-67 staining was observed in the thrombosis group compared to uncomplicated veins (p < 0.01).
  
  
  CONCLUSIONS
  The vein wall in SVT shows increased pro-apoptotic activity compared to uncomplicated disease and normal veins. Whether increased vein wall cell apoptosis is a causative factor for SVT in varicose veins disease or a repairing mechanism of the thrombosis itself needs further research.
authors.affiliation: Division of Vascular Surgery, First Department of Propaedeutic Surgery, University of Athens Medical School, Hippokration Hospital, Athens, Greece.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Filis
authors.affiliation: First Department of Pathology, University of Athens Medical School, Athens, Greece.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Kavantzas
authors.affiliation: Department of Vascular Surgery, University of Athens Medical School, Athens, Greece.
authors.forename: Ilias
authors.initials: I
authors.lastname: Dalainas
authors.affiliation: Division of Vascular Surgery, First Department of Propaedeutic Surgery, University of Athens Medical School, Hippokration Hospital, Athens, Greece.
authors.forename: George
authors.initials: G
authors.lastname: Galyfos
authors.affiliation: Division of Vascular Surgery, First Department of Propaedeutic Surgery, University of Athens Medical School, Hippokration Hospital, Athens, Greece.
authors.forename: Evridiki
authors.initials: E
authors.lastname: Karanikola
authors.affiliation: Division of Vascular Surgery, First Department of Propaedeutic Surgery, University of Athens Medical School, Hippokration Hospital, Athens, Greece.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Toutouzas
authors.affiliation: First Department of Cardiology, University of Athens Medical School, Athens, Greece.
authors.forename: Constantinos
authors.initials: C
authors.lastname: Tsioufis
authors.affiliation: Division of Vascular Surgery, First Department of Propaedeutic Surgery, University of Athens Medical School, Hippokration Hospital, Athens, Greece.
authors.forename: Fragiska
authors.initials: F
authors.lastname: Sigala
mesh_terms: D000328:Adult; D017209:Apoptosis; D051017:Apoptosis Regulatory Proteins / Q000032:analysis; D015415:Biomarkers / Q000032:analysis; D016022:Case-Control Studies; D049109:Cell Proliferation; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D019394:Ki-67 Antigen / Q000032:analysis; D008297:Male; D008875:Middle Aged; D012501:Saphenous Vein / Q000737:chemistry / Q000473:pathology*; D014648:Varicose Veins / Q000150:complications / Q000378:metabolism / Q000473:pathology*; D020246:Venous Thrombosis / Q000209:etiology / Q000378:metabolism / Q000473:pathology*
chemical_list: D051017:Apoptosis Regulatory Proteins; D015415:Biomarkers; D019394:Ki-67 Antigen
keywords: Superficial vein thrombosis; apoptosis; varicose veins; vein wall