Ehrler Michaela, Heim Dominik, Mouton Wolfgang G
Department of Surgery, Spitalzentrum Biel, Switzerland.
Department of Surgery, Klinik Hohmad, Switzerland.
EJVES Vasc Forum. 2021 Jun 17;52:17-19. doi: 10.1016/j.ejvsvf.2021.06.005. eCollection 2021.
The primary aim of this study was to assess the histopathological criteria of neovascularisation following saphenofemoral high ligation with regard to the delineation of the pathophysiology of the process. The secondary aims were to describe the perivenous morphological changes and to present cost effective agents to histopathologically diagnose neovascularisation.
In a prospective study design, vein samples of consecutive patients with recurrent varicose veins in the groin undergoing surgery were collected. The samples were analysed by a vascular histopathologist with a light microscope using standard staining techniques.
The study population comprised 35 patients, 24 of whom were female (69%). Histopathologically, 28 samples (80%) showed typical aspects of neovascularisation. The remaining seven specimens (20%) showed thickened residual veins. An irregular vascular network, increasing perivenous collagen and elastic fibres and perivenous lymph nodes were observed. Present venous valves were the main criterion for residual veins. A surprising finding was the presence of scar tissue in the views of reparative incomplete new valves. Standard staining agents were sufficient to make the diagnosis of neovascularisation in 73% of the samples and reduced the cost by 30% compared with the regular use of specific markers.
The histopathological analysis of operative specimens may clarify whether a varicose vein recurrence is the result of neovascularisation or some other cause. Although interesting for research, academic interest, and classification, this may be of very limited clinical relevance for the patient.
本研究的主要目的是评估大隐静脉高位结扎术后新生血管形成的组织病理学标准，以明确该过程的病理生理学。次要目的是描述静脉周围的形态学变化，并提出具有成本效益的组织病理学诊断新生血管形成的方法。
采用前瞻性研究设计，收集连续腹股沟复发性静脉曲张手术患者的静脉样本。样本由血管组织病理学家使用标准染色技术在光学显微镜下进行分析。
研究人群包括35例患者，其中24例为女性（69%）。组织病理学检查显示，28个样本（80%）呈现典型的新生血管形成特征。其余7个样本（20%）显示残留静脉增厚。观察到不规则的血管网络、静脉周围胶原纤维和弹性纤维增加以及静脉周围淋巴结。现存的静脉瓣膜是残留静脉的主要标准。一个令人惊讶的发现是，在修复不完全的新瓣膜视野中存在瘢痕组织。标准染色剂足以对73%的样本做出新生血管形成的诊断，与常规使用特定标记物相比，成本降低了30%。
手术标本的组织病理学分析可以明确静脉曲张复发是新生血管形成还是其他原因所致。尽管这对于研究、学术兴趣和分类很有意义，但对患者的临床相关性可能非常有限。
