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XXVIII Пленум Правления Белорусской ассоциации хирургов
«Актуальные вопросы и современные подходы в оказании
хирургической помощи в Республике Беларусь»
18-19 ноября 2021 года в г. Минск.
Year 2012 Vol. 20 No 5
GENERAL AND SPECIAL SURGERY
MORPHOLOGICAL CHANGES OF THE PRETERMINAL SECTION OF THE GREAT SAPHENOUS VEIN AT VARICOSE VEINS OF THE LOWER LIMBS
EE “Vitebsk State Medical University”
The Republic of Belarus
Objectives. To estimate the character of the morphological changes in the preterminal section of the great saphenous vein in different terms starting from the disease onset and in various forms of varicose veins.
Methods. Histological preparations of the removed great saphenous vein of 21 patients with the primary varicose veins of the C2-C6 (CEAP) clinical classes were studied. The examination was carried out by means of the light microscopy at magnification. The state of the venous wall and the character of the morphological changes, which were determined according to the severity of the prevailing pathological processes in the intima, media and adventitia, were estimated.
Results. Morphological structural disturbances in the preterminal section of the great saphenous vein were found out to be represented by the combination of elastolysis, atrophic and sclerotic changes, and hypertrophy involving all layers of the venous wall. On the basis of the pathological processes severity 3 nominal types of venous wall changes are singled out: with prevalence of sclerotic changes on the moderate hypertrophy background; with prevalence of atrophic changes and with marked hypertrophic changes. Severity of the connective tissue destruction, sclerotic changes and hypertrophy correlate with the main disease duration if a positive variant correlation is present in case of sclerosis-hypertrophy and a negative one in case of atrophy-sclerosis, atrophy-hypertrophy.
Conclusions. Pathological morphological changes in the preterminal section of the great saphenous vein are detected at early stages including minor forms of the disease. The most marked character of the connective tissue destruction is observed at early terms of the pathology development. While the disease is progressing, prevalence of the sclerotic changes and of hypertrophy is observed on the background of the severity reduction of the destructive processes of the connective tissue. The given changes show the systemic character of the vascular wall lesion at varicose veins and can predetermine the early character of failure development of the terminal valvular apparatus of the great saphenous vein in case of the given pathology.
1. Sansilvestri-Morel P, Rupin A, Badier-Commander C, Fabiani JN, Verbeuren TJ. Chronic venous insufficiency: dysregulation of Collagen Synthesis. Angiology. 2003 Jul-Aug;54(Suppl. 1):S13–8.
2. Pappas P, Duran W, Hobson R. Pathology and cellular physiology of chronic venous insufficiency. In: Handbook of venous disorders. Guidelines of American Venous Forum. Arnold, London–New York–New Deli; 2001. p. 58–67.
3. Pistorius MA. Chronic Venous Insufficiency: the Genetic Influence. Angiology. 2003 Jul-Aug;54(Suppl. 1):S5–12.
4. Jawien A. The Influence оf Environmental Factors in Chronic Venous Insufficiency. Angiology 2003 Jul-Aug;54(Suppl. 1):S19–31.
5. Stotter L, Schaaf I, Bockelbrink A. Comparative outcomes of radiofrequency endoluminal ablation, invagination stripping and cryostripping in the treatment of great saphenous vein insufficiency. Phlebology. 2006;21(2):60–64.
6. Cappelli M, Lova RM, Ermini S, Turchi A, Bono G, Bahnini A, Franceschi C. Ambulatory conservative hemodynamic management of varicose veins: critical analysis of results at 3 years. Ann Vasc Surg. 2000 Jul;14(4):376–84.
7. Maeso J, Juan J, Escribano J, Allegue NM, Di Matteo A, Gonzalez E, Matas M. Comparison of clinical outcome of stripping and CHIVA for treatment of varicose veins in the lower extremities. Ann Vasc Surg. 2001 Nov;15(6):661–65.
8. Bobrik II, Shevchenko EA, Cherkasov V.G. Razvitie krovenosnykh i limfaticheskikh sosudov [The development of blood and lymphatic vessels]. Kiev, Ukraina: Zdorov'ia; 1991. 207 p.
9. Allegra C, Bonifacio M, Carlissa A. Idiopathic venous insufficiency. Phlebolymphology. 1999;(10):5–8.
10. Vankov VN. Stroenie ven [The structure of the veins]. Moscow, RF: Meditsina; 1974. 207 p.
11. Aunapu M, Arend A. Hystopathological changes and expression of adhesion molecules and laminin in varicose veins. Vasa. 2005 Aug;34(3):170–75.
12. Wali MA, Dewan M, Eid RA. Hystopathological changes in the wall of varicose veins. Int Angiol. 2003 Jun;22(2):188–93.
13. Tsukanov IuT, Tsukanov AIu. Flebopatiia kak narushenie viazko-uprugikh svoistv stenki ven i faktory, vliiaiushchie na ee klinicheskoe techenie pri varikoznoi bolezni [Phlebopathy as a violation of a visco-elastic properties of the vein wall and the factors influencing on its clinical course in varicose veins]. Flebolimfologiia, 2003;(18):8–13.
14. Porto LC, da Silveira PR, de Carvalho JJ, Panico MD. Connective tissue accumulation in the muscle layer in normal and varicose saphenous veins. Angiology. 1995 Mar;46(3):243–9.
15. Stucker M, Krey T, Rochling A, Schultz-Ehrenburg U, Altmeyer P. The hystomorphologic changes at the saphenofemoral junction in varicosis of the greater saphenous vein. Vasa. 2000 Feb;29(1):41–6.
210023, Respublika Belarus, g. Vitebsk, pr-t Frunze, d. 27, UO «Vitebskiy gosudarstvennyiy meditsinskiy universitet», kafedra gospitalnoy khirurgii s kursami urologii i detskoy khirurgii
Krishtopov Andrey Leonidovich
Krishtopov A.L. Senior Lecturer of the Hospital Surgery with the Course of Urology and Pediatric Surgery Chair of EE “Vitebsk State Medical University”.
Myadelets O.D. Doctor of Medical Sciences, Professor, Head of the Histology, Cytology and Embryology Chair of EE “Vitebsk State Medical University”.