ULTRASTRUCTURAL CHANGES IN THE WALL OF THE GREAT SAPHENOUS VEIN AT THE VARICOSE DISEASE OF VEINS OF LOWER LIMBS DEPENDING ON AGE AND ILLNESS DURATION

Abstract

The aim of the study was features of ultrastructural changes in cellular elements and connective tissue carcass of the great saphenous vein (GSV) at varicose disease in depending on the duration of the disease in persons of different ages. An examination by light microscopy of 133 fragments of BPV, excised during phlebectomy in 19 patients, and an electron microscopic examination of 532 preparations were performed. Depending on the age of the patients, four age groups was distinguished: 18-44 years old (young people); 45-59 years (middle-aged people); 60-74 years old (the elderly), 75-90 years old (persons of senile age). In the wall of the GSV of young people with a small duration of the disease, there were poorly expressed pathomorphological changes characterized by moderately expressed endothelial dysfunction and minor hypertrophy of smooth muscle cells (SMC) of the middle shell. In the group of middle-aged people, in addition to age-related changes in the structure of the wall of varicose dilated GSV, pathological changes are noted that are characteristic of the long course of the disease with the development of endothelial dysfunction. The phenotypic heterogeneity of the SMC in the middle shell intensifies, and the communication links between them is altered. Disorganization of connective tissue leads to a decrease in the strength of the connective tissue vein skeleton. Hypertrophy of SMC, as a universal compensatory-adaptive response of cells, develops in response to an increase in functional load with hemodynamic disturbances in the veins of the lower limbs and to compensate for the quantitative deficiency of SMC as a result of their death. In elderly and senile age the duration of varicose disease is more than 10 years, on average - up to 25-30 years. The number of destructively altered SMC is increasing, degenerative processes and sclerotic changes are progressing. The ultrastructural analysis of biopsies showed that at the initial stage of development of varicose disease in young people with a small duration of varicose disease, morphological changes in the structure of the GSV wall are poorly expressed. With the increase in the age of the patient and the duration of the disease, changes in GSV are progressed. Involute degenerative-dystrophic changes are most pronounced in patients over 60 years of age and are an aggravating factor during varicose transformation of the GSV wall. In elderly and senile age, the compensatory possibilities of the cells decrease, the sclerotic degenerative changes in the wall of the GSV are progressed.