The scanning electron microscope in the pathology of varicose veins

We studied varices of the lower limb by scanning electron microscope (SEM) in 29 women who had undergone surgery under local anesthesia for symptomatic varicose veins. Their ages ranged between 19 and 42 years (average 30). They were all diagnosed as having incompetence of the valve at the saphenofemoral junction. The surgical procedure was high ligation of the long saphenous vein, excision of the upper portion of the vein and multiple excision of all the varices along the leg through several tiny incisions. Segments of the removed varices and the upper portion of the long saphenous vein were prepared and studied by the Jeol scanning electron microscope (Japan, model 355c). We found no changes in the intima or adventitia and no changes in any of the upper valves of the saphenous vein; however, varying degrees of thinning of the media of the venous wall were seen, which coincided with the areas of varicose dilatation between areas that retained their normal configuration. Our study therefore supports the "weak vein wall" theory concerning the etiology of varicose veins, and confirms that surgery for varicose veins of the lower limb must concentrate on removal of the varices themselves. Since these often lie outside the long saphenous vein, routine stripping is neither advisable nor effective.