Regularities of morphological rearrangement of the great saphenous vein wall at different levels of the lower extremities in different periods of a person’s life

Sannikov A.B.; Shaĭdakov E.V.; Emel’yanenko V.M.

doi:https://doi.org/10.17116/operhirurg2020404128

Close metadata

OBJECTIVE

The aim of the study was to investigate the general regularities and qualitative differences of morphological reconstruction of the great saphenous vein (GSV) at different levels of the lower extremities in normal status and different periods of human life.

MATERIAL AND METHODS

The structure of the GSV wall in 30 human died from various causes at three age groups (5—10, 20—30 and 60—80 years) was studied by light microscopy. Sections of the GSV were excised in various segments of the limb (upper third of the thigh, middle third of the lower leg, and medial ankle).

RESULTS

In the early age period (5—10 years), active proliferation of the main elastic-contractile elements of the GSV wall was observed in all three shells. The GSV wall was represented by monolayer soft elastic connective tissue fibers with a well-represented endothelial cell layer and signs of the Genesis of circular smooth muscle fibers, evenly distributed in all layers; no changes in the structure of collagen fibers were obtained. The stromal elements of the vein wall are a single three-dimensional network with a predominant arrangement of elastic fibers in the longitudinal direction. Analysis of changes in the second group (20—30 years) showed a high degree of activity of continuing proliferative and beginning hypertrophic processes in the GSV wall. Structural changes on the part of smooth muscle fibers of the wall corresponded to the morphological picture of loading smooth muscle concentric hypertrophy. Reconstruction of the connective tissue backbone of the GSV wall morphologically corresponded to reactive connective tissue concentric hyperplasia. A typical manifestation of age—related involution processes occurring at various levels of the lower limb in the GSV wall in the elderly group (60—80 years) was age-reducing smooth muscle hypotrophy and structural changes in the connective tissue elements of the GSV wall at all levels of the limb. These changes corresponded to the morphological picture of the general age-related fibrotic involution with the appearance of trabecular thickening in the sub-endothelial layer of intima and active collagen proliferation of all layers.

CONCLUSION

Based on the research results’ analysis, it was possible to determine the formal genesis of the ongoing morphological reconstruction of the GSV wall over the course of a person’s life, taking into account different levels of limb. The obtained data will be the basis for further research in order to show the dynamics of morphological changes from the norm through moderate ectasia of the vein to its pronounced varicose transformation. This material will be submitted for discussion in the near future as well.

Keywords:

great saphenous vein (GSV)

venous wall

sheath the walls of the veins

genesis of morphological reorganization

norm

chronic venous diseases

varicose veins

Authors:

Sannikov A.B.

Clinic of Innovative Diagnostics «Medica»;
Pirogov National Research Medical University

Shaĭdakov E.V.

N.I. Bekhtereva Institute of the Human Brain

Emel’yanenko V.M.

Pirogov National Research Medical University

Received:

26.04.2020

Accepted:

09.06.2020

Close metadata

References:

Gloviczki P, Comerota AJ, Dalsing MC, Eklof Bo G, Gillespie DL. The care of patients with varicose veins and associated chronic venous diseases: Clinical Practice Guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg. 2011;53(5):2S-48S. https://doi.org/10.1016/j.jvs.2011.01.079
Criqui MH, Jamosmos M, Fronek A. Chronic venous disease in an ethnically diverse population: The San Diego Population Study. Submitted 2002, San Diego population study. J Vasc Surg. 2004;37(5):823-828. https://doi.org/10.1093/aje/kwg166
Savel’ev VS, Gologorskij VA, Kirienko AI. Phlebology. A guide for doctors, by ed Savel’ev V.S. M.: Meditsina, 2001. (In Russ.). https://www.search.rsl.ru
Konstantinova GD, Zubarev AR, Gradusov EG. Phlebology. M.: Vidar-M; 2000. (In Russ.). https://www.search.rsl.ru
Eklof B, Perrin M, Delis KT, Rutherford RB, Glovieszki P. Updated terminology of chronic venous disorders: the Vein-Term transatlantic interdisciplinary consensus document. J Vasc Surg. 2009;49(2):498-501. https://doi.org/10.1016/j.jvs.2008.09.014
Shevchenko YuL, Stojko YuM. Fundamentals of clinical phlebology. M.: Shiko; 2013. (In Russ). https://www.search.rsl.ru
Heuser RR, Henry M. Textbook of Peripheral Vascular Interventions. CRC-Press. 2008. https://doi.org/10.3109/9781439801970
Bergan J, Pascerella L. Venous Anatomy, Physiology, and Pathophysiology. Book Chapter in The Vein Book. Academic Press. 2007. https://doi.org/10.1016/b978-012369515-4/50007-7
Vasudeva N, Mishra S. Textbook of Human Histology (With Color Atlas and Practical Guide). New Delhi: Medical College; 2016. https://doi.org/10.5005/jp/books/12918
Hem A, Kormak D. Histology. Ed. Afanasieva Yu.I., Chentsova Yu.S. In 5 volumes. V. 4. M.: Mir; 1983. (In Russ.). https://www.search.rsl.ru
D’Alessandro MP, Bergman RA. Anatomy Atlases, copyright, 1995—2020. https://www.anatomyatlases.org
Eliseev VG. Histology. M.: Medgiz; 1963. (In Russ.). https://www.search.rsl.ru
Afanas’ev YuI, Yurina NA, Kotovskij EF. Histology, embryology, Cytology. Textbook. 6th ed. M.: GEOTAR-Media; 2012. (In Russ.). https://www.medpoiskpro.ru
Vedenskij AN. Varicose disease. L.: Meditsina, 1983. (In Russ.). https://www.search.rsl.ru
Gladkih VG, Firsov EF, Lazarenko VA, Shevelev EL. Assessment of changes in the deep veins of the lower extremities in varicose disease. Khirurgiya. Zhurnal im. N.I. Pirogova. 1989;9:83-87. (In Russ.). https://www.mediasphera.ru
Sukovatyh BS, Nazarenko PM, Belikov LN. The main regularities of transmission of vertical blood reflux from the deep veins of the hip to the superficial veins in patients with varicose disease. Vestnik Khirurgii im. I.I. Grecova. 1990;7:38-42. (In Russ.). https://www.vestnik-grekova.ru
Sannikov AB, Sukovatyh BS, Nazarenko PM. Pathogenetic role of retrograde blood flow in the deep veins of the lower extremities in the development of decompensated forms of varicose disease. Angiologiya i Sosudistaya khirurgiya. 1998;3-4:31-37. (In Russ.). https://www.angiolsurgery.org
Vedenskij AN. Plastic and reconstructive operations on the main veins. Leningrad. 1979. (In Russ.). https://www.search.rsl.ru
Gavrilenko AV, Sandrikov VA, Vahrat’yan PE. The role of femoral vein valvular insufficiency in the course and recurrence of lower limb varicose disease. Angiologiya i Sosudistaya khirurgiya. 2006;12(3):61-66. (In Russ.). https://www.angiolsurgery.org
Vedenskij AN. Peculiarities of blood flow and functions of venous valves in the lower extremities. Vestnik Khirurgii im. I.I.Grecova. 1989;6:40-43. (In Russ.). https://www.vestnik-grekova.ru
Vedenskij AN, Zajceva KK, Stojko YuM. Electron microscopic studies of the valves of the deep veins of the lower extremities. Arkhiv patologii. 1990;4:21-24. (In Russ.). https://www.mediasphera.ru, https://www.search.rsl.ru
Diagnostics and treatment of Chronic Venous Disease: Guidelines of Russian Phlebology Association clinical guidelines for the diagnosis and treatment of chronic venous diseases. Flebologiya. 2018;3:146-240. (In Russ.). https://doi.org/10.17116/flebo20187031146
SHevchenko YuL, Stojko YuM, Mazajshvili KV. Laser surgery for varicose veins. «Borges». 2010. (In Russ.). https://www.search.rsl.ru
Shevchenko YuL, Stojko YuM, Clinicalphlebology. M.: Press; 2016. (In Russ.). https://www.dpk-press.ru
Abduvosidov HA, Makeeva EA, Kolesnikov LL. Morphological parameters of lower limb vein wall components in people of different age groups. Morfologiya. 2017;152(6):29-34. (In Russ.). https://www.docviewer.yandex.ru
Abduvosidov HA, Kolesnikov LL. Chenges of volumes of structural components of a great saphenous vein with age and in varicose disease. Morfologicheskie vedomosti. 2018;26(1):20-23. (In Russ.). https://doi.org/10.20340/mv-mn.18(26).01.20-23
Chekmareva IA, Abduvosidov HA, Paklina OV, Makeeva EA, Kolesnikov LL. Ultrastructiral changes in the wall of the great saphenous vein at the varicose disease of veins of lower lims depending on age and illness duration. Morfologicheskie vedomosti. 2018;26(2):26-31. (In Russ). https://doi.org/10.20340/mv-mn.18(26).02.26-31
Zav’yalov AV, Sannikov AB, Lazarenko VA, Komissarov VI, Snegireva LV. To the question of physiology and pathology of venous circulation of the lower extremities. Kurskii Nauchno-prakticheskii vestnik «Chelovek i ego zdorov’e». 2002;1:9-15. (In Russ.). https://www.kursk-vestnik.ru
Shval’b PG, Uhov YuI. Pathology of venous return from the lower extremities. Ryazan’, 2009. (In Russ.). https://www.rzgmu.ru
Vankov VN. The structure of the veins. M.: Meditsina; 1974. (In Russ.). https://www.alib.ru
Tkachenko BI. Venous circulation. M.: Meditsina; 1979. (In Russ.). https://www.search.rsl.ru
Val’dman VA. Diseases of the venous vascular system. Leningrad: Meditsina; 1967. (In Russ.). https://www.search.rsl.ru
Dumpe EP, Uhov YuI, Shval’b PG. Physiology and pathology of venous circulation of the lower extremities. M.: Meditsina; 1982. (In Russ.). https://www.rzgmu.ru
Yarovaya IM. Organ features of the histological structure of the wall of venous vessels and their age-related changes. In book «Essays on hemodynamic reconstruction of the vascular wall». M.: Meditsina; 1971. (In Russ.). https://www.search.rsl.ru
Bujan J, Jimenez-Cossio JA, Jurado F. Evalution of the smooth muscle cell component and apoptosis in varicose vein wall. Histol Histopathol Cell Mol Biol. 2000;15:745-752. https://doi.org/10.14670/HH-15.745
Rose SS, Ahmed A. Some thoughts on the aetiology of varicose veins. J Cardiovasc Surg. 1986;27(5):534-543. https://www.ncbi.nlm.nih.gov
Travers JP, Brookes CE, Evans J, Baker DM, Kent C, Makin GS, Mayhow TM. Assessment of wall structure and composition of varicose veins with reference to collagen, elastin and smooth muscle content. Eur J Vasc Endovasc Surg. 1996;11(2):230-237. https://www.ncbi.nlm.nih.gov
Bouissou H, Julian M, Pieraggi MT, Louge L. Vein morphology. Phlebology. 1998;3:1-11. https://www.phlebolymphology.org
Gistologiya dlya budushchikh vrachei: testy dlya effektivnogo osvoeniya tsitologii, embriologii i gistologii. Pod red. A.V. Pavlova, A.N. Gansburgskogo. SPb.: SpetsLit, 2011..
Wali MA, Eid RA. Intimal changes in varicose veins: an ultrastructural study. J Smooth Muscle Res. 2002;38(3):63-74. https://doi.org/10.1540/jsmr.38.63
Benda C. Venen. Handbuch der speziellen pathologischen. Anatomie und Histologie. Berlin. 1924. https://www.springer.com
Caggiati A. Fascial relations and structure of the tributaries of the saphenous veins. Surg Radiol Anatomy. 2000;22(3-4):191-196. https://doi.org/10.1007/s00276-000-0191-3
Khan AA, Eid RA, Hamdi A. Structural changes in the tunica intima of varicose veins; a histopathological and ultrastructural study. Pathology. 2000;32(4):253-257. https://doi.org/10.1080/pat.32.4.253.257
Wali MA, Eid RA. Smooth Muscle Changes in Varicose Veins: An Ultrastrustural Study. J Smooth Muscle Rec. 2001;37(5-6):123-135. https://doi.org/10.1540/jsmr.37.123
Tal’man IM. Varicose veins of the lower extremities. L.: Medgiz; 1961. (In Russ.). https://www.search.rsl.ru
Makeeva GF. Morphological changes of the lower limb vein wall in varicose veins. Khirurgiya. Zhurnal im. N.I. Pirogova. 1956;9:66-71. (In Russ.). https://www.mediasphera.ru
Porto LC, Alves Azizi MA, Pelagro-Machado M. Elastic fiberes in Saphenous Varicose Veins. Angiology. 2002;53(2):131-140. https://doi.org/10.1177/000331970205300202
Jurukova Z, Milenkov C. Assessment of wall structure and composition of varicose veins with reference to collagen, elastin and smooth muscle content. Exp Mol Pathol. 1982;37(1):37-47. https://doi.org/10.1016/0014-4800(82)90020-x
Venturi M, Bonavina L, Annoni F, Colombo L, Butera C, Peracchia A, Mussini E et al. Biochemical assay of collagen and elastin in the normal and varicose vein wall. J Surg Res. 1996;60(1):245-248. https://doi.org/10.1006/jsre.1996.0038
Griffith OM, Stuehr DJ. Nitric oxide synthases: properties and catalytic mechanisms. Ann Rev Physiol. 1995;57:707-736. https://doi.org/10.1146/annurev.ph.57.030195.003423
Gout B. Impaired endothelium-dependent relaxation by adrenomedullin in monocrotaline-treated rat arteries. Eur J Pharmacol. 1999;380(1):23-30. https://doi.org/10.1016/s0014-2999(99)00519-1
Kalinin RE, Suchkov IA, Novikov AN, Mnihovich MV, Pshennikov AS. Experimental modeling and correction of venous endothelial dysfunction. M.: GEOTAR-Media; 2015. (In Russ.). https://www.labirint.ru
Porto LC, da Silveira PR, de Carvalho JJ, Panico MD. Connective tissue accumulation in the muscle layer in normal and varicose saphenous vein. Angiology. 1995;3:243-249. https://doi.org/10.1177/000331979504600308
Tonar Z, Thomas Kural Jr, Petra Kochova. Vasa vasorum quantification in human varicose great and small saphenous vein. Ann Anatomy. 2012;194:473-481. https://doi.org/10.1016/j.aanat.2012.02.019
Elsharawy MA, Naim MM, Abdelmaguid EM, Al-Mulhim AA. Role of saphenous vein wall in the pathogenesis of primary varicose veins. Interactive CardioVasc Thor Surg. 2006;6(2):219-224. https://doi.org/10.1510/icvts.2006.136937
Tonara Z, Kural Jr. T, Kochova P. Vasa vasorum quantification in human varicose great and small saphenous veins. Ann Anatomy. 2012;194:473-481. https://doi.org/10.1016/j.aanat.2012.02.019
Shajdakov EV, Bulatov VL, Chumasov EI, Petrova ES, Son’kin IN, Chernyh KP. Structural features of the varicose great saphenous vein in patients of different age groups. Novosti khirurgii. 2014;22(5):560-567. (In Russ.). https://doi.org/10.18484/2305-0047.2014.5.560
Sannikov AB, Emel’yanenko VM, Rachkov MA, Drozdova IV. The anatomical structure of the venous collector of the gastrocnemius muscle according to multispiral computed tomography venography. Operativnaya khirurgiya i klinicheskaya anatomiya. 2019;3(1):19-26. (In Russ.). https://doi.org/10.17116/operhirurg2019301119
Sannikov AB, Emel’yanenko VM, Rachkov MA, Drozdova IV. The anatomical structure of the venous collector of the soleus muscle according to multispiral computed tomography venography. Operativnaya khirurgiya i klinicheskaya anatomiya. 2019;3(2):5-12. (In Russ.). https://doi.org/10.17116/operhirurg201930214
Shajdakov EV, Sannikov AB, Emel’yanenko VM, Rachkov MA, Drozdova IV. Variants of ecstatic development of the leg intramuscular veins in patients with chronic venous diseases according to multispiral computed tomography phlebography. Operativnaya khirurgiya i klinicheskaya anatomiya. 2019;3(3):22-30. (In Russ.). https://doi.org/10.17116/operhirurg2019303122