A Journey across the Wall of Varicose Veins: What Physicians Do Not Often See with the Naked Eye

Abstract

Objective: To examine varicose veins (VVs) from inside out in order to help surgeons and general practitioners better understand the pathogenesis of the disease and improve their management. Material and Methods: A comprehensive examination of the wall of VVs was performed using transmission electron microscopy. The ultrastructural morphology of the collagen, elastin and smooth muscle content of the wall was analyzed in a sample of 10 patients (4 male and 6 female) and 10 matched controls aged between 37 and 50 years. Results: Analysis of the tunica media revealed that the smooth muscle cells were significantly separated from each other by a marked increase in amorphous and fibrous tissue in which many of the collagen and elastin fibers lost their normal structural arrangement. The cells contained a large number of membrane-bound intracellular vesicles and cytoplasmic vacuoles. The collagen fibers were smaller and thinner than what is commonly seen in normal veins, and they were widely separated from each other. A light electron-lucent center was observed in the middle of the fibers. Similar changes were also seen in the intima and were associated with irregular plaque-like intimal thickening. Conclusion: Our study revealed a significant separation among smooth muscle cells in the wall of VVs, and the presence of an abnormal amorphous extracellular matrix and intracytoplasmic vacuoles could reflect ‘unusual’ possible secretory and phagocytic roles of smooth muscle cells. This could provide an important explanation for the abnormal contractile function of these cells in VVs.

IQGAP1 modulates the proliferation and migration of vascular smooth muscle cells in response to estrogen

“…In a previous study, it was demonstrated that VSMCs in varicose veins were poorly differentiated, with an increase in secretory cytoplasmic organelles, which possibly reflects the unusual synthetic and secretory roles of VSMCs. A reduction in filament bundles was also observed, which suggests a decreased contractility of VSMCs in varicose veins (19).…”

Evaluation of aFGF/bFGF and FGF Signaling Pathway in the Wall of Varicose Veins

“…That is closely linked to changed activity of enzymes involved in ECM degradation, as well as to smooth muscle cells (SMCs) phenotype modulation from a contractile to a synthetic one [9][10][11]. Furthermore, SMCs hypertrophy is also found in the varicose vein wall [12].…”

In Vivo and In Vitro Assessment of Human Saphenous Vein Wall Changes

“…The results of a previous study [22] clearly demonstrated intimal hypertrophy and hyperplasia of the subendothelial smooth muscle cells in saphenous varicose vein samples. Also they reported that the changes in the subendothelial smooth muscle cells did not correlate with any changes in the endothelial cells of the varicose veins studied.…”