Abstract
Chronic venous disease (CVeD) is defined as a set of disorders affecting the venous system mainly manifested in the form of varicose veins. CVeD is characterized by a sustained venous hypertension, leading to a plethora of functional and structural changes in the vein that may cause valve incompetence and pathologic reflux. In turn, venous reflux aggravates the venous hypertension and enhances the progression of CVeD into the most advanced stages. Previous studies have proposed that there are several alterations in the venous wall preceding the valve dysfunction and venous reflux. Besides, it has also been identified that young patients with CVeD present premature aging and changes in the venous wall composition that may be related to the presence of venous reflux. In this context, the aim of the present study is to examine the possible pathophysiological role of elastic fibers and their precursors in the venous wall of patients with reflux in comparison to those without reflux, considering the variable age in both groups (<50 years and ≥50 years). We performed immunohistochemical and quantitative polymerase chain reaction (PCR) in order to assess the protein and gene expression of tropoelastin, fibrillin-1, fibulins 4 and 5, lysyl oxidase and lysyl oxidase like 1, respectively. In parallel, we assessed the elastin content through histological techniques (orcein stain) in this group of patients. Our results show significant changes in elastic fibers and their precursors in young patients with pathologic reflux when compared with elder patients with reflux and young patients without reflux. These variations suggest that the venous system of young patients with venous reflux appears to present an enhanced dynamism and arterialization of the venous wall, which may be associated with a premature aging and pathological environment of the tissue.
Highlights
Chronic venous disease (CVeD) comprises a set of functional and structural disorders affecting the venous system, which is a highly prevalent but underestimated global concern [1]
The study cohort was selected according to the following criteria: Inclusion criteria: men and women men diagnosed with CVeD with or without venous reflux in the great saphenous vein, Body mass index (BMI) ≤ 25, commitment to follow-up during pre- and postoperative periods, signed informed consent and permission for tissue collection to develop gene and histopathological studies
This study revealed differences in the number of elastic fibers depending on the presence or absence of venous reflux and the age of the patients
Summary
Chronic venous disease (CVeD) comprises a set of functional and structural disorders affecting the venous system, which is a highly prevalent but underestimated global concern [1]. The classification of CVeD is performed following the Clinical-Etiology-AnatomyPathophysiology (CEAP) criteria, considering the main clinical manifestations, causes, veins affected and pathophysiological mechanisms involved [2]. In this sense, varicose veins (VVs) are the most common clinical sign of CVeD, corresponding to the C2 classification. According to the Framingham study, the incidence of VVs is slightly superior in women than in men and it is frequently associated with the exposure to some risk factors like lower levels of physical activity, higher body mass index and systolic blood pressure or menopause [4]. VVs and CVI, rather than being an esthetic or local concern, may cause pain, heaviness and discomfort, and they may even be related with more serious consequences like deep venous thrombosis, some types of neoplasia or depression [6]
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