Does extracellular matrix of the varicose vein wall change according to clinical stage?
Mehmet Ali Demirkıran1, Cüneyt Köksoy2, Aylin Okçu Heper3, Uğur Bengisun2
1Clinic of General Surgery, Şehitkamil State Hospital, Gaziantep, Turkey<
2Department of General Surgery, Division Peripheral Vascular Surgery, Ankara University Faculty of Medicine, Ankara, Turkey
3Department of Pathology, Ankara University Faculty of Medicine, Ankara, Turkey
Abstract
Objective: The etiology and pathophysiology of chronic venous disease is not fully understood. This study aimed to determine the variation in varicose vein wall extracellular matrix proteins according to clinical stage.
Material and Methods: Forty varicose and 10 control veins were sampled from the saphenofemoral junction. The Clinical Etiologic Anatomic Pathophysiologic (CEAP) classification was used in patients with varicose veins. Samples were stained with hematoxylin-eosin, Masson’s trichrome, EVG (Elastica-van Gieson) stain and with laminin, fibronectin, tenascin antibodies. Stained samples were examined immunohistologically. Changes in extracellular matrix were determined semi-quantitatively using light microscopy.
Results: It was observed that in the early stages (C2-C3) of chronic venous disease, fibrosis is increased in the intima and media layers, with fragmentation in lamina elastica interna, and increased tenascin expression in the intima layer. In advanced stages (C4-C6), the accumulation of tenascin in the intima continued along with fibrosis in the media layer, the thickness of the media layer increased and fibronectin deposition was observed.
Conclusion: This study showed that changes first occur in the intima during the early stages of the disease with addition of alterations in the media layer at later stages.
Keywords: Chronic venous disease, varicose veins, extracellular matrix proteins, CEAP
Ethics committee approval was received for this study from the ethics committee of Ankara University Faculty of Medicine.
Written informed consent was obtained from patients who participated in this study.
Externally peer-reviewed.
Concept - U.B., M.A.D.; Design - U.B., M.A.D.; Supervision - U.B., M.A.D.; Funding - U.B., M.A.D., C.K.; Materials - U.B., M.A.D., C.K.; Data Collection and/or Processing - U.B., M.A.D., C.K., A.O.H.; Analysis and/or Interpretation - U.B., M.A.D., C.K., A.O.H.; Literature Review - U.B., M.A.D., C.K., A.O.H.; Writer - U.B., M.A.D.; Critical Review - U.B., M.A.D., C.K., A.O.H.
No conflict of interest was declared by the authors.
This study was supported by grants from The Turkish Surgical Association and Sanofi Synthelabo Thrombosis Research Foundation and Ankara University Scientific Studies Project Department.