Intimal changes in varicose veins: an ultrastructural study

In order to study the structural changes in the intimal layer of varicose veins, we prospectively collected a total of 23 vein specimens from both the normal proximal thigh long saphenous (LSV) in 3 young trauma patients and from the unstripped proximal LSV near the sapheno-femoral junction and the distal calf blowouts in 10 primary varicose veins patients. Paraffin sections stained with hematoxylin and eosin were examined under the light microscope while ultra-thin sections were examined under the transmission electron microscope (TEM). Compared with the normal control LSV, varicose vein sections showed increase in the diameter of the lumen, hypertrophy of the wall and elongation and invagination of the intima. Along these invaginations, endothelial cells were compressed, elongated and thinned out. The cells also showed progressive degeneration and were finally lost into the lumen, leaving only the basal lamina to form the luminal surface. This invited blood components like platelets and red blood cells to stick to the bare intima and to penetrate through the wall. This may form the basis of the clinical condition of superficial thrombophlebitis, which sometimes complicates cases of varicose veins. In conclusion, varicose veins showed increased diameter of the lumen and hypertrophy, elongation and invagination of the intima. There was marked degeneration of the endothelial cells and desquamation of the endothelial layer.