Venous morphology predicts class of chronic venous insufficiency

Abstract

Objectives: this study aimed to determine specific morphological differences in long saphenous veins from patients with various grades of venous insufficiency. Design: comparable veins from a control group were compared with patients with either primary varicose veins or those with associated skin changes including venous ulcers. Materials: below-knee segments of saphenous vein were examined from a total of 64 patients. Methods: veins were examined for elastic-tissue disruption and endothelial-cell changes and comparisons made between clinical groups. Results: elastic-tissue disruption, as measured by fragmentation of the elastic lamina and the percentage of the intimal-medial boundary containing elastin, increased with increasing severity of venous disease. Moreover, endothelial cells became more densely packed, as measured by endothelial cell and endothelial-cell nuclei density, with increasing severity of disease. Other measures such as the density of multinucleated 'giant' endothelial cells and the number of nuclei per 'giant' cell did not correlate with venous disease, however. Conclusions: this study demonstrates that several morphological characteristics of superficial saphenous veins correlate with severity of venous disease. In particular, the alterations to the structure of elastic tissue within these veins appears indicative of the progressive nature of chronic venous insufficiency.