Study On The Cause And Clinical Signification Of Vascular Remodeling Of Varicose Veins In The Lower Extremities

Objective To explore the cause,process and clinical signification of varicose veins in the lower extremities by comparing variations between proximal and distal histologial composition of normal and varicose veins Methods Endothelial cells and smooth muscle cells in 17 cases of varicose and 3 normal veins were examined by light microscopy, verhoeff iron-hemaoxylin staining, imunohistochemitry, transmission electron microscopy.Result (1) The endothelial cells(ECs) in the proximal wall of normal veins were flat and tight, intima thickness was 51.66 + 26.48 ; Part of distal EC were round and scattered ,distal intima thickness was 180+ 33.32 (mm*100). Smooth muscle cells were seen in the base of valves. ECs were seen lost in the cells toward wall of veins but cells toward lumen were complete and tight. Longitude smooth muscle cells (SMCs)were seen in the proximal but mainly circle ones in the distal normal veins.(2)AREA of positive Nitric Oxide Synthase(NOS, endothelial cell NOS)in ECs was 754. 5 + 102. 22 in normal veins, 1015 + 192. 89 in the compensation stage and 393 + 46. 85 in the decompensation stage, q was equal to 4.96 to compare the normal with compensation and 11.83 to compare compensation with decompensation, both P<0. 05. OPTDM of positive NOS in the ECs of valve toward wall was 1. 31+0. 12 and 3. 16+0. 12 toward lumen in the normal veins; 2.32 + 0.08 toward wall and 2.64 + 0.07 toward lumen in compensation; 1.52 + 0.04 toward wall and 1.72 + 0.05 toward lumen in decompensation stage, (both P <0.01).(3)0PTDM of positive a-actin in SMCs was 3440.40+102.39 in normal veins, Positive cells were seen in the valves during the early stage of varicose veins, with the development of vascular remodeling , a -actin was decreasing .OPTDM was 11680. 8 + 305. 99 in the compensation and 55 + 10.05 in the decompensation stage, q was equal to 4.08 to compare the normal with compensation and 5.51 to compare compensation withdecompensation ,both P <0.05.(4)0PTDM of positive NOS in Ecs of wall and valves toward wall at the same level was 3.30 + 0.1, 3.16 + 0.1 in the normal, 2. 60 + 0. 09, 2. 64 +0.07 in the compensation and 1.91 + 0.06 , 4.05 + 0. 12 in the decompensation stage , both P>0. 05. OPTDM of positive NOS in vascular remodeling from the proximal to the distal was 1. 91 +0. 06, 4. 05+0. 12 and 0.82 + 0.02, 2. 13 + 0. 10 from the distal to the proximal, both p<0.01; OPTDM of positive a-actin was 1.66 + 0.06 , 50.88 + 0.04 from the proximal to the distal and 4.72 + 0.06, 9.40 + 0.08 from the distal to the proximal, both P< 0.01.Conclusion (1) There is also histologial difference between the proximal and the distal wall in the normal veins.(2) Function of ECs to synthesis NOS in the varicose veins is most active in the compensation and inactive in the decompensation stage which show that there is a gradual process for function of ECs from compensation to decompensation. The similar alterations is also seen in ECs of valves toward venous and lumen.(3) Function of smooth muscle cells to synthesis a-actin is highest in the compensation and lowest i n the decompensation stage which show that there is also a procedure for function of SMCs from compensation to decompensation. Smooth muscle cells(SMCs) of varicose veins are seen to migrate to high-tention but thinner regions in the early stage;with the development of varicose veins , SMCs are transitional from the contractile phenotype to synthetic phenotype with decreasing a-actin.(4)There is no difference between the venous wall and valve at the same level and no regular vascular remodeling is found at different site in the same veins namely "no sequence for vascular remodeling" .(5)nomal stage, compensation stage and decompensation stage can be defined in the sequence process of the varicose veins.