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Despite numerous theories, the etiology and pathogenesis of primary varicose veins remain unclear. The etiology of chronic venous diseases (CVDs) known as chronic venous insufficiency (CVI) is related to leukocyte trapping. Leukocyte trapping involves trapping of white cells in vessel walls followed by their activation and translocation outside the vessel. Release of reactive oxygen species (ROS) from trapped white cells has been documented. Superoxide dismutase (SOD) directly inhibits the generation of free radicals and compounds that are produced during oxidation by ROS, such as malonyldialdehyde (MDA). The aim of this study was to determine the involvement of free radicals in the etiology of venous changes. The following material was used for the study: fragments of sufficient or insufficient venous system and varices from 31 patients diagnosed with chronic venous disease in the 2nd or 3rd degree, according to clinical state, etiology, anatomy and pathophysiology (CEAP), which were qualified for surgical procedure. The levels of oxidative stress markers strongly correlated with lesions observed by USG in insufficient and varicose veins. In both a higher concentration of MDA was observed, which is a sign of lipid peroxidation. Antioxidative mechanisms, SOD activity and total antioxidative power expressed as FRAP were inversely proportional to MDA concentration. In insufficient and varicose veins both FRAP and SOD activities were significantly lower than in normal veins. The severity of clinical changes was inversely dependent on the efficiency of scavenging of ROS, which additionally proves the participation of free radicals in pathogenesis of CVDs.
The aim of the study was to show the changes in the great saphenous vein (GSV) wall at consecutive stages in the development of chronic vein disease (CVD) in patients qualified for a surgical procedure after physical examination and Doppler ultrasonography. Four groups of patients were formed (C2, C3, C4 and C5/6) according to clinical stage of the CEAP classification (C — clinical signs, E — aetiopathology, A — anatomy and P —pathophysiology). After the surgical procedure for removal of the varicose GSVs, 40 segments were harvested from their proximal parts near the saphenofemoral junction, 10 segments for each CEAP group. The veins were sectioned transversally and stained with the resorcin-fuchsin and AZAN method to visualise the elastic end collagen fibres. Afterwards the specimens were analysed under an optical microscope and photographed. As the GSV is an elastic vessel and its wall is divided into three zones, namely the internal layer (intima), the medial layer (media) and the external layer (adventitia), we found a proliferation of the connective tissue among the smooth muscle cells inside the internal and medial layers at consecutive stages of CVD. The later stages of CVD also revealed a larger number of the elastic and collagen fibres inside the intima and media and a looser arrangement of the smooth muscle cells of the media in the GSV wall.
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