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4 . 2020

Formal genesis of morphological changes of the great saphenous vein wall on the calf in various periods of human life, with the development of its ectasia and varicose transformation

Abstract

Background. Structural changes in the great saphenous vein (GSV) wall on the calf are not taken into account when choosing the treatment tactics and method of varicose vein obliteration, which may be one of the reasons for recanalization and relapse of varicose disease.

Aim - to study the dynamics of morphological changes in the GSV wall on the calf in different periods of human life, with the development of ectasia and varicose transformation.

Material and methods. The study of morphological rearrangement of the GSV wall on the calf was performed by light microscopy in 9 comparison groups: norm (5-10 years), norm (20-30 years), norm (60-80 years), ectasia (up to 7 mm), ectasia (up to 10 mm), ectasia (>10 mm), varicose veins (up to 5 cm), varicose veins (up to 15 cm), varicose veins (up to 15 cm). In groups 1-3, the structure of the GSV wall was studied on autopsy material of people who died from various causes. In 4-9 groups, fragments of GSV in the calf were taken by biopsy (miniphlebectomy) during the execution of the operations for varicose veins. All patients (C2-C3 clinical classes according to СЕАР) underwent ultrasound mapping before surgery to determine the presence and degree of ectasia, varicose transformation, and retrograde blood flow. For histological analysis in groups, 140 fragments of GSV on the calf were removed in groups 1-3, 165 fragments in groups 4-6, and 250 fragments in groups 7-9. In order to conduct a quantitative analysis of the nature of structural changes in the smooth muscle and connective tissue elements of the GSV wall on the calf, a visual analog scale of morphological changes was developed - Visual Analog Morphology Scale (VAMS), in which a certain number of points (from 1 to 10) corresponded to a certain character of morphological changes. Statistical analysis of the obtained data in groups was performed using the IBM SPSS Statistica software package (USA). The statistical analysis included comparison of the main characteristics of descriptive statistics by a two-sample t-test based on the student's criterion calculated by the program. Hypothesis testing for adequacy was performed using linear regression calculations using the Fischer test by calculating the regression coefficient (Beta).

Results. The general morphological analysis of histological preparations made it possible to visually identify various variants of changes in smooth muscle and connective tissue elements inherent in the inner, middle and outer shells of the GSV wall. The selected variants of venous wall elements rearrangement were combined into 10 morphological types. Further histological analysis in the groups was carried out in accordance with Visual Analog Morphology Scale (VAMS) in each case, the morphological picture was evaluated in points. The quantitative and statistical analysis of changes in smooth muscle and connective tissue elements in the comparison groups allowed us to establish their gradual restructuring in the GSV wall on the lower leg from normal and minor ectasia to pronounced varicose transformation.

Conclusion. Age-related morphological changes in the smooth muscle and connective tissue elements in the GSV wall on the calf, during the life of a humane, do not have the same character as changes occurring in its wall during the development of its ectasia and varicose transformation. At each stage of ectasia development and progression of varicose process, in the GSV wall on calf there are morphological changes characteristic of this stage of connective tissue and smooth muscle elements of the venous wall. The established morphological changes of the GSV wall on the calf should be taken into account when choosing the method of obliteration in the treatment of patients with varicose disease.

Keywords:great saphenous vein, venous wall, vein wall sheaths, smooth muscle elements of the vein wall, connective tissue elements of the vein wall, genesis of morphological reconstruction of the vein wall, age norm of the histological structure of veins, vein ectasia, chronic venous diseases, varicose veins

Funding. The study had no sponsor support.
Conflict of interests. The authors declare no conflict of interests.
Contribution. Collection and analysis of research results - Sannikov A.B.; research design - Shaydakov E.V.; final editing - Emelynenko V.M.
For citation: Sannikov A.B., Shaydakov E.V., Emelynenko V.M. Formal genesis of morphological changes of the great saphenous vein wall on the calf in various periods of human life, with the development of its ectasia and varicose transformation. Clinical and Experimental Surgery. Petrovsky Journal. 2020; 8 (4): 74-86. DOI: https://doi.org/10.33029/2308-1198-2020-8-4-74-86 (in Russian)

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CHIEF EDITOR
CHIEF EDITOR
Sergey L. Dzemeshkevich
MD, Professor (Moscow, Russia)

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