Analysis of the connective tissue matrix and proteolytic activity of primary varicose veins

Gandhi, Raju H.; Irizarry, Evelyn; Nackman, Gary B.; Halpern, Vivienne J.; Mulcare, Robert J.; Tilson, M. David

doi:10.1016/0741-5214(93)90336-k

Cited by 132 publications

(106 citation statements)

References 19 publications

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“…In one study, active MMP-1 and total MMP-2 decreased, whereas total MMP-1 did not change in VVs (Gomez et al, 2014). Interestingly, measurements of collagen content in VV walls also showed variable results ranging from an increase (Gandhi et al, 1993) to no change (Kockx et al, 1998) to a decrease (Haviarova et al, 1999). The variability in MMP levels may be caused by examining VV segments from different regions, i.e., atrophic versus hypertrophic regions, or veins from patients at different stages of CVD, or failure to distinguish between pro-MMP and active forms of MMP.…”

Section: Mmp Levels In Vvsmentioning

confidence: 99%

“…However, venous dilation and VVs are often seen below competent valves (Naoum et al, 2007). Also, increased collagen and decreased elastin have been demonstrated in both VVs and competent saphenous vein segments in proximity to varicosities, suggesting that ECM imbalance may occur in the vein wall prior to valve insufficiency (Gandhi et al, 1993). These observations led to the suggestion that primary vein wall dilation may cause the valves to become distorted and dysfunctional, leading to venous reflux and higher venous pressure, ultimately causing more venous dilation and VVs (Raffetto and Khalil, 2008b).…”

Section: Matrix Metalloproteinases In Varicose Veinsmentioning

confidence: 99%

“…Measurements of collagen content in VV walls have shown variable results ranging from an increase (Gandhi et al, 1993) to a decrease (Haviarova et al, 1999) or no change (Kockx et al, 1998). Both cultured dermal fibroblasts from patients with CVD and cultured VSMCs from VVs show increased synthesis of type I collagen but decreased synthesis of type III collagen, despite normal gene transcription, suggesting that VV patients may have a systemic abnormality in collagen production and post-translational inhibition of type III collagen synthesis in various tissues.…”

Section: Structural and Functional Abnormalities In Vvsmentioning

confidence: 99%

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Matrix Metalloproteinases as Regulators of Vein Structure and Function: Implications in Chronic Venous Disease

MacColl

Khalil

2015

J Pharmacol Exp Ther

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Lower-extremity veins have efficient wall structure and function and competent valves that permit upward movement of deoxygenated blood toward the heart against hydrostatic venous pressure. Matrix metalloproteinases (MMPs) play an important role in maintaining vein wall structure and function. MMPs are zinc-binding endopeptidases secreted as inactive pro-MMPs by fibroblasts, vascular smooth muscle (VSM), and leukocytes. ProMMPs are activated by various activators including other MMPs and proteinases. MMPs cause degradation of extracellular matrix (ECM) proteins such as collagen and elastin, and could have additional effects on the endothelium, as well as VSM cell migration, proliferation, Ca 21 signaling, and contraction. Increased lower-extremity hydrostatic venous pressure is thought to induce hypoxia-inducible factors and other MMP inducers/ activators such as extracellular matrix metalloproteinase inducer, prostanoids, chymase, and hormones, leading to increased MMP expression/activity, ECM degradation, VSM relaxation, and venous dilation. Leukocyte infiltration and inflammation of the vein wall cause further increases in MMPs, vein wall dilation, valve degradation, and different clinical stages of chronic venous disease (CVD), including varicose veins (VVs). VVs are characterized by ECM imbalance, incompetent valves, venous reflux, wall dilation, and tortuosity. VVs often show increased MMP levels, but may show no change or decreased levels, depending on the VV region (atrophic regions with little ECM versus hypertrophic regions with abundant ECM) and MMP form (inactive pro-MMP versus active MMP). Management of VVs includes compression stockings, venotonics, and surgical obliteration or removal. Because these approaches do not treat the causes of VVs, alternative methods are being developed. In addition to endogenous tissue inhibitors of MMPs, synthetic MMP inhibitors have been developed, and their effects in the treatment of VVs need to be examined.

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Section: Mmp Levels In Vvsmentioning

confidence: 99%

Section: Matrix Metalloproteinases In Varicose Veinsmentioning

confidence: 99%

Section: Structural and Functional Abnormalities In Vvsmentioning

confidence: 99%

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Matrix Metalloproteinases as Regulators of Vein Structure and Function: Implications in Chronic Venous Disease

MacColl

Khalil

2015

J Pharmacol Exp Ther

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“…Muchos estudios, incluyendo éste, hacen referencia al aumento de colágeno en la pared de la vena varicosa (14),(21) (22), que es más evidente a nivel de la capa media, causando separación entre las células musculares lisas (23). También se han encontrado diferencias en las fibras elásticas, más evidentes en la tinción con orceína.…”

Section: Discussionunclassified

Histological analysis of the wall of a healthy and varicose vein and their correlation with their biomechanical properties

Mingorance¹,

Izquierdo²,

Morata³

et al. 2014

Actual. Med.

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Análisis histológico de la pared de la vena sana y varicosa y su correlación con sus propiedades biomecánicas ResumenObjetivos: Las varices son una enfermedad muy frecuente en la población, cuya patogenia aun no está clara. Los cambios en la pared de la vena varicosa respecto a la sana determinan su comportamiento biomecánico y la aparición de varices. El presente estudio tiene por objetivo establecer dichas características estructurales en la pared de la vena sana y varicosa, su correlación con los cambios biomecánicos y su contribución a la patogenia de las varices. Métodos: Se llevó a cabo un estudio descriptivo tomando 10 muestras de vena varicosa de pacientes intervenidos de varices mediante crosectomía de la unión safenofemoral, y 4 muestras de vena sana en pacientes sometidos a amputación en los que se descartó enfermedad venosa previa. Las muestras fueron procesadas para su análisis histológico con microscopía óptica con las tinciones de hematoxilina-eosina, orceína y picrosirius. Se determinaron las propiedades biomecánicas en ambos grupos, calculándose el esfuerzo y deformación de ruptura, así como el módulo elástico medio. Resultados: Se han observado cambios histológicos en la pared de la vena varicosa respecto de la sana, con engrosamiento a nivel intimal y en la capa media, aumento de fibras colágenas, disminución de elásticas y alteración de la morfología de las células musculares lisas que pierden su orientación característica. Asimismo se ha encontrado un menor esfuerzo y deformación de ruptura y una mayor rigidez en el grupo de venas varicosas. Dichas alteraciones contribuyen a la deformidad de la pared venosa y la incompetencia valvular, implicados en la aparición de varices. Conclusiones: Las alteraciones histológicas observadas en la pared de la vena varicosa pueden correlacionarse con los cambios en las características biomecánicas y con el proceso patogénico que favorece la aparición de varices. AbstractPurpose: Varicose veins are a very common disease, whose pathogeny still remains unclear. Changes in the varicose vein wall in relation to the normal vein, determine its biomechanical behaviour and the appearance of varicose veins. The purpose of this study is to correlate structural and biomechanical properties of healthy and varicose veins, and its contribution to the appearance of varicose veins. Methods: A descriptive study was performed. 10 samples were taken from patients who underwent varicose vein surgery, which consisted in crosectomy of the safeno-femoral junction, and 4 samples of healthy vein from patients who underwent major amputation after dismissing those with signs or symptoms of venous disease. Results: Histological changes have been observed in the varicose vein wall in relation to the healthy vein, consisting in intimal and media thickening, increased amount of collagen fibres, decrease of elastic fibres, and lack of characteristic morphology and orientation in muscular cells. In addition, a lower strain and deformation rupture, and high stiffness has been observed in va...

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“…They occur due to defect in the strength and characteristics of the venous wall. There is significant increase in the collagen content with significant reduction in the elastin contents of these veins [1]. They affect 5 % or more of adult population of western countries [2].…”

Section: Discussionmentioning

confidence: 99%

Taking Up Subfascial Endoscopic Perforator Surgery for Patients of Lower Limb Varicose Veins with Below Knee Perforators, in A Government Medical College–A Review of Eleven Cases

2012

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Varicose veins are the most common manifestation of chronic venous insufficiency (CVI) worldwide. They interfere with the patients' daily activities and hamper their professional endeavors, and therefore need to be addressed at the earliest with the best tools. Eleven patients of varicose veins of the lower limb with below knee perforators underwent subfascial endoscopic perforator surgery (SEPS) from October 2010 to December 2011 in our institute. The procedure was successfully completed in all 11 patients. The mean operating time was 78 min (60-96 min). The results showed a favorable outcome for the patients in terms of faster recovery and less morbidity.

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Analysis of the connective tissue matrix and proteolytic activity of primary varicose veins

Cited by 132 publications

References 19 publications

Matrix Metalloproteinases as Regulators of Vein Structure and Function: Implications in Chronic Venous Disease

Matrix Metalloproteinases as Regulators of Vein Structure and Function: Implications in Chronic Venous Disease

Histological analysis of the wall of a healthy and varicose vein and their correlation with their biomechanical properties

Taking Up Subfascial Endoscopic Perforator Surgery for Patients of Lower Limb Varicose Veins with Below Knee Perforators, in A Government Medical College–A Review of Eleven Cases

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