title: The Morphofunctional Changes in the Wall of Varicose Veins.
abstract: BACKGROUND
  Varicose vein (VV) disease is a frequently occurring pathology of the lower extremities. Although the pathogenesis of varicosity development is not clearly defined, the final common pathway leading to chronic venous insufficiency is the development of venous hypertension, which is associated with severe changes in the venous wall. The aim of this study was to clarify the histological and immunohistochemical changes in great saphenous veins (GSVs) in chronic venous insufficiency.
  
  
  METHODS
  A histopathological study was conducted on 20 patients with VVs (4 males, 16 females) and 4 (1 male, 3 females) patients undergoing distal bypass surgery. Tissues were processed for histological routine straining and immunohistochemical studies of vascular endothelial growth factor (VEGF), intercellular adhesion molecule (ICAM)-1, vascular adhesion molecule (VCAM)-1, protein gene product 9.5 (PGP 9.5), and collagen type IV, laminin, and fibronectin. A semiquantitative evaluation method was used.
  
  
  RESULTS
  Compared with the normal SV, VV sections showed the damaged endothelium areas, significant disorganization of the smooth muscle bundles, and highest density of the vasa vasorum in the tunica media and tunica adventitia, as well as sclerotic blood vessels and neoangiogenesis in almost all specimens. Immunohistochemistry study showed statistically significant difference between the VVs and the control group of several parameters, such as PGP 9.5 positive structures (P < 0.05; 1-tailed significance) and laminin positive structures in subendothelial layer of VVs (P < 0.05; 1-tailed significance). There is also the tendency in increasing of VEGF expression and decreasing of collagen IV structures. Our study did not show statistically significant difference in VEGF, ICAM-1, and VCAM-1 positive structures between varicose and normal veins; however, it could be explained by the limitations of the study.
  
  
  CONCLUSIONS
  Varicose GSVs represent nonhomogeneous integrity of the basement membrane, smooth muscle disorganization, and active neoangiogenesis, suggesting remodulation of blood vessels. Changes in the appearance of PGP 9.5-containing innervation, laminin, and collagen IV in tunica intima confirm the remodulation of damaged blood vessels.
authors.affiliation: Department of Morphology, Institute of Anatomy and Anthropology, Riga Stradins University, Riga, Latvia. Electronic address: jelena.birdina@gmail.com.
authors.forename: Jeļena
authors.initials: J
authors.lastname: Birdina
authors.affiliation: Department of Vascular Surgery, Riga East Clinical University Hospital "Gaiļezers", Vascular Surgery Centre, Riga, Latvia.
authors.forename: Māra
authors.initials: M
authors.lastname: Pilmane
authors.affiliation: Department of Morphology, Institute of Anatomy and Anthropology, Riga Stradins University, Riga, Latvia.
authors.forename: Artūrs
authors.initials: A
authors.lastname: Ligers
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000032:analysis; D002908:Chronic Disease; D024141:Collagen Type IV / Q000032:analysis; D005260:Female; D005353:Fibronectins / Q000032:analysis; D006801:Humans; D007150:Immunohistochemistry; D018799:Intercellular Adhesion Molecule-1 / Q000032:analysis; D007797:Laminin / Q000032:analysis; D008297:Male; D008875:Middle Aged; D012501:Saphenous Vein / Q000737:chemistry / Q000473:pathology*; D043222:Ubiquitin Thiolesterase / Q000032:analysis; D014648:Varicose Veins / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D019010:Vascular Cell Adhesion Molecule-1 / Q000032:analysis; D042461:Vascular Endothelial Growth Factor A / Q000032:analysis; D066253:Vascular Remodeling; D014689:Venous Insufficiency / Q000378:metabolism / Q000473:pathology* / Q000601:surgery
chemical_list: D015415:Biomarkers; D024141:Collagen Type IV; D005353:Fibronectins; C573420:ICAM1 protein, human; D007797:Laminin; C482860:UCHL1 protein, human; C467484:VEGFA protein, human; D019010:Vascular Cell Adhesion Molecule-1; D042461:Vascular Endothelial Growth Factor A; D018799:Intercellular Adhesion Molecule-1; D043222:Ubiquitin Thiolesterase