Crotty T P
Department of Physiology, University College, Cork, Ireland.
Med Hypotheses. 1996 Dec;47(6):449-54. doi: 10.1016/s0306-9877(96)90156-5.
The first section of this paper reviews the clinical, histochemical and histological features of the varicosity in the early stage of human varicose veins. The second section demonstrates that many of those features have been duplicated in acute experiments where noradrenaline perfused the vasa venarum of an isolated in situ canine vein segment, the drug having reached the vasa by reflux from the lumen of the segment (radial reflux). It also explains how perfusion of the vasa for an extended period would duplicate other distinctive features of the early-stage human varicosity, such as its permanence, the hypoxia of its tissues and the hypertrophy of the smooth muscle in its wall. The findings further support the hypothesis that varicose veins arise from chronic perfusion of the vasa venarum of a normal vein by circulating noradrenaline contained in pathologically high volumes of radial venous reflux. The main cause of the high volume of reflux seems to be turbulent luminal flow in the case of secondary varicose veins and a real or relative structural deficiency of the fibroelastic of the valve aggers in the case of primary ones.
本文第一部分回顾了人类静脉曲张早期阶段静脉曲张的临床、组织化学和组织学特征。第二部分表明，在急性实验中，许多这些特征已被复制，在这些实验中，去甲肾上腺素灌注离体原位犬静脉段的静脉血管，药物通过从段腔（径向反流）反流到达血管。它还解释了长时间灌注血管如何复制早期人类静脉曲张的其他独特特征，如其持久性、组织缺氧和壁内平滑肌肥大。这些发现进一步支持了这样的假设，即静脉曲张是由病理高容量的径向静脉反流中所含的循环去甲肾上腺素对正常静脉的静脉血管进行慢性灌注引起的。反流高容量的主要原因在继发性静脉曲张中似乎是管腔内血流紊乱，而在原发性静脉曲张中是瓣膜集合纤维弹性的实际或相对结构缺陷。
