El Wajeh Y, Giannoukas A D, Gulliford C J, Suvarna S K, Chan P
Sheffield Vascular Institute, Northern General Hospital, Sheffield S5 7AU, UK.
Eur J Vasc Endovasc Surg. 2004 Dec;28(6):590-4. doi: 10.1016/j.ejvs.2004.09.011.
Recurrence of varicose veins after apparently adequate surgery is common. Neovascularisation, the formation of new vascular channels between a venous surgery site and new varicosities, is thought to be an important cause of recurrence. The aim of this study was to provide histological evidence of the 'neovascularisation'process.
Tissue samples from the region of the previously ligated saphenofemoral junction (SFJ) were taken from 14 limbs with recurrent varicose veins and from nine control limbs. Tissue samples were analysed histologically for overall vascularity, and the presence of intimal circular fibrosis, intimal eccentric fibrosis, medial thickened elastosis, and thrombosis in the microscopic thin walled vessels within the tissue. The same samples were analysed immunohistoligically for S100, a neural marker, and Ki-67 (Mib 1), a marker of endothelial proliferation. Absent S100 and positive Ki-67 were considered as evidence of new vessels.
No significant difference was found between the venous recurrence and control groups in respect to histological features. S100 positive nerve fibrils were seen associated with dilated venous channels in the majority of both redo and control groups (p=1, Fisher's exact test). Only one section stained positively with Ki-67 (Mib1) in a single vascular channel for a few endothelial cells. The remaining control and redo cases were negative for Mib 1 (p=1, Fisher's exact test).
We found little evidence of neovascularisation associated with recurrent varicose veins in the saphenofemoral region. The venous channels that develop at the previously ligated SFJ may represent adaptive dilatation of pre-existing venous channels (vascular remodelling), probably in response to abnormal haemodynamic forces.
在看似手术充分的情况下，静脉曲张复发很常见。新生血管形成，即在静脉手术部位与新出现的静脉曲张之间形成新的血管通道，被认为是复发的一个重要原因。本研究的目的是提供“新生血管形成”过程的组织学证据。
从14例复发性静脉曲张肢体和9例对照肢体中获取先前结扎的隐股交界处（SFJ）区域的组织样本。对组织样本进行组织学分析，以评估总体血管情况，以及组织内微小薄壁血管中内膜环形纤维化、内膜偏心纤维化、中膜增厚弹性组织变性和血栓形成的情况。对相同样本进行免疫组织化学分析，检测神经标志物S100和内皮细胞增殖标志物Ki-67（Mib 1）。S100阴性且Ki-67阳性被视为新血管的证据。
在组织学特征方面，静脉复发组和对照组之间未发现显著差异。在大多数再次手术组和对照组中，均可观察到S100阳性神经纤维与扩张的静脉通道相关（p = 1，Fisher精确检验）。在单个血管通道中，只有一个切片的少数内皮细胞Ki-67（Mib1）染色呈阳性。其余对照组和再次手术组Mib 1均为阴性（p = 1，Fisher精确检验）。
我们几乎没有发现与隐股区域复发性静脉曲张相关的新生血管形成的证据。在先前结扎的SFJ处形成的静脉通道可能代表先前存在的静脉通道的适应性扩张（血管重塑），可能是对异常血流动力学力的反应。
