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Intimal fibrosis (phlebosclerosis) in the saphenous vein of the lower limb: a quantitative analysis
1Department of Cardiology, Medical Clinic, University Hospital Eppendorf, Hamburg, Federal Republic of Germany.
Insights
Pre-existing phlebosclerosis, or vein wall hardening, may impact the success of aorto-coronary bypass grafts. Histological analysis revealed intimal thickening in saphenous veins, correlating with graft patency.
Area of Science:
- Vascular Surgery
- Histopathology
- Cardiovascular Research
Background:
- The patency of aorto-coronary bypass grafts is crucial for long-term cardiovascular health.
- Pre-existing conditions of the saphenous vein, such as phlebosclerosis, may influence graft performance.
- Quantitative histological assessment of vein intima is needed to understand these influences.
Purpose of the Study:
- To investigate the relationship between pre-existing phlebosclerosis in the saphenous vein and aorto-coronary bypass graft patency.
- To quantitatively assess intimal thickness in saphenous veins using histological methods.
Main Methods:
- Quantitative histological analysis of intimal thickness in 30 left saphenous veins.
- Morphometric measurements using planimetric, four-point, and estimation methods.
- Correlation of intimal thickness with the degree of phlebosclerosis.
Main Results:
- Saphenous vein intima was consistently thickened by collagen, elastic fibers, and smooth muscle cells.
- The method of estimate proved to be the most time-efficient for measuring intimal thickness.
- Intimal thickness measurements correlated with the severity of phlebosclerosis, with values <100 microns indicating mild/moderate thickening and 100-250 microns suggesting moderate/severe fibrosis.
Conclusions:
- Phlebosclerosis, characterized by intimal thickening, is a common finding in saphenous veins used for bypass grafting.
- The degree of intimal thickening provides a histological indicator of the vein's condition and potential impact on graft patency.
- Histological assessment of intimal thickness is valuable for predicting saphenous vein suitability for bypass surgery.
Abstract:
The influence of pre-existing phlebosclerosis on the patency rate of aorto-coronary bypasses is uncertain. To examine this influence, extensive quantitative histological investigations of the intimal thickness of the left saphenous vein were made in 30 cases. In almost all veins the intima was thickened by collagen and elastic fibres as well as by fusiform cells which were assumed to be smooth muscle cells. The innermost layers also contained increased collagen adding to the intimal thickening. Three different methods to measure the intimal thickness were tested morphometrically: planimetric, a four-point method and a so-called method of estimate. The latter is the most time-saving and effective method. The average intimal thickness showed considerable deviations, but the intimal thickness in individual veins did not deviate greatly. As a rule, a specimen with an intimal thickness of less than 100 microns belonged to a vein with mild or moderate intimal thickening, but specimens with an average intimal thickness of 100-250 microns usually derived from a vein with moderate or pronounced intimal fibrosis. However, extreme values allowed a more precise statement to be made. A specimen with a nonsclerotic intima suggested at best a mild intimal fibrosis of the vein in the lower limb, whereas a specimen with marked intimal thickening derived from a vein with severe phlebosclerosis.