Neovascularization and recurrent varicose veins: more histologic and ultrasound evidence André M van Rij, MD, FRACS, Gregory T Jones, PhD, Gerry B Hill,

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Presentation transcript:

Neovascularization and recurrent varicose veins: more histologic and ultrasound evidence André M van Rij, MD, FRACS, Gregory T Jones, PhD, Gerry B Hill, BSc Hons, Ping Jiang, MBChB Journal of Vascular Surgery Volume 40, Issue 2, Pages 296-302 (August 2004) DOI: 10.1016/j.jvs.2004.04.031

Fig 1 Duplex ultrasound imaging of a recurrent saphenofemoral junction. The patient was a 57-year-old man with images taken during the Valsalva maneuver. Top, A small, but apparently single, channel (arrow) can be seen forming the recurrent junction (in transverse plane), with 3 smaller channels present distally (arrowhead). Bottom, Multiple channels (above the deep fascia (arrow) are shown in longitudinal section in a region 1.5 cm distal to that shown on top (proximal to left side). Journal of Vascular Surgery 2004 40, 296-302DOI: (10.1016/j.jvs.2004.04.031)

Fig 2 Top, Surgical dissection of a recurrent saphenofemoral junction from a 62-year-old woman. The recurrent junction is well formed (looped) and almost as if the site has been previously untouched. Bottom, Excised recurrent saphenofemoral junction specimen showing the typical wide opening where the stump has been transected at the femoral vein and channels entering into it (scale in mm). Journal of Vascular Surgery 2004 40, 296-302DOI: (10.1016/j.jvs.2004.04.031)

Fig 3 Vessel morphology within recurrent saphenofemoral junctions. A and B, Abundant neovascular channels, by far the most common vessel type observed. These vessels were lined by a simple squamous endothelium overlying a medial layer consisting of 2 to 5 layers of vascular smooth muscle. The wall of these vessels lacked elastic fibers, intramural nerves (identified by PGP 9.5 immunostaining), and a distinct adventitia. C, Small residual vessels. These vessels contained distinct medial and adventitial layers. Fine (arrowheads), though often disrupted (arrow), elastic fibers were also present within the vein wall, particularly along the intimal medial border. D, Distended (residual) vessels. These vessels also contained distinct intimal, medial, and adventitial tunica. Abundant elastic tissue (stained black) was present both along the intimal-medial border and within the adventitia. Some regions of the vein wall contained relatively normal structure, including intact medial and adventitial elastic tissue and only modest intimal thickening (arrows). In contrast, other segments of the same vein contained medial atrophy, elastic tissue disruption (arrowheads), and extensive compensatory intimal thickening (asterisk). Verhoeff's elastic tissue stain counterstained with van Gieson's. Scale bars: A and D, 200 μm; B and C, 50 μm. Journal of Vascular Surgery 2004 40, 296-302DOI: (10.1016/j.jvs.2004.04.031)

Fig 4 Recannulated putative long saphenous vein near saphenofemoral junction. The patient (female 76 years) had undergone previous groin tie plus avulsions. The vessel has multiple tortuous lumens (asterisks), indistinct tunica, and a lack of elastic fibers. Verhoeff's elastic tissue stain; scale bar: 50 μm. Journal of Vascular Surgery 2004 40, 296-302DOI: (10.1016/j.jvs.2004.04.031)

Fig 5 Vascular casts of recurrent refluxing saphenofemoral junction specimens. Casts injected from the saphenofemoral junction show resin present in the connecting network of vessels. Notice the variation in the size of the abundant tortuous vessels in both specimens. A, Though several channels are larger, there are more than 100 channels running in a similar proximal distal direction. B, Three large-diameter tortuous channels dominate the cast; however, there are also many small channels present in continuity. Note the injecting cannula (distal). Scale bars: A, 5 mm; B, 10 mm. Journal of Vascular Surgery 2004 40, 296-302DOI: (10.1016/j.jvs.2004.04.031)