Blood vessels of the normal and pathologically changed wall of the human vena saphena magna

Abstract

<jats:title>Abstract</jats:title><jats:p>The vascular supply of the wall of human vena saphena magna was qualitatively studied by the use of several morphological methods on both normal and pathologically changed veins. The material was obtained from patients undergoing aortocoronary bypass or surgery of the varices, and material from cadavers. Under physiological conditions, the wall of vena saphena magna is supplied by delicate system of vasa vasorum, organized in a form of feeding vessels branched into an irregular loose adventitial mesh and continuing further as a microcirculatory network supplying the two outer thirds of the media. Small local dilatations and tortuosities of adventitial veins were found on heavy varicose veins. Slight increase of vasa vasorum growing into the innermost layer of media was detected, but the hyperplastic intima remained avascular. In patients with recurrent varices or with vein thrombophlebitis intimal hyperplasia, degradation of media and thrombosis, were found. Apparent massive increase of vasa vasorum growing into the whole media, hyperplastic intima and into the organizing thrombi, were regularly observed. The increase of vasa vasorum is a part of the complex of pathophysiological reactions of the vein wall on the hypoxia developing during the most serious pathological changes, and not as the primary varicogenic factor. The vascular supply of the wall of the human vena saphena magna was qualitatively studied by the use of several morphological methods on both normal and pathologically changed veins. The material was obtained from patients undergoing aortocoronary bypass grafting or surgery of varices, as well as materials from cadavers. Under physiological conditions the wall of vena saphena magna is supplied by a delicate system of vasa vasorum. It is organized in a form of feeding vessels branched into an irregular loose adventitial mesh, which continues further as a microcirculatory network supplying the outer two thirds of the media. Small local dilatations and tortuosities of adventitial veins were found on severe varicose veins. A slight increase of the vasa vasorum growing into the innermost layer of media was detected, but the hyperplastic intima remained avascular. In patients with recurrent varices or vein thrombophlebitis, intimal hyperplasia, degradation of media and thrombosis, were found. It was regularly observed that there was an apparent, massive increase of the vasa vasorum growing into the entire media, hyperplastic intima, and into the organizing thrombi. The increase of the vasa vasorum is due to the pathophysiological reaction of the vein wall as a result of hypoxia, which develops during the most serious pathological changes. The increase is not the primary varicogenic factor.</jats:p>

Characterization of the Vasa Vasorum in the Human Great Saphenous Vein: A Scanning Electron Microscopy and 3D-Morphometry Study Using Vascular Corrosion Casts

“…Whether the VV terminate in the stem of the HGSV or not has been heavily discussed. While some authors describe such a connection (Souza et al, 1999; Dashwood et al, 2004), our results are consistent with previous findings—gained via India ink and VCC—reported by Kachlík et al (2003, 2007, 2008 a ). If the VV empties into the lumen of the HGSV there would be at least short stumps of casting media visible at the luminal side of the HGSV.…”

“…Hence, it can be concluded that the VV of the HGSV undergo structural changes in disease and so the vascular density increases in order to provide sufficient nourishment of the diseased vessel wall. This finding is consistent with the findings of Kachlík et al (2008 a , 2008 b ), who reported an increase of new VV in the pathologically changed vessel wall of the HGSV.…”

“…By microdissection we were able to verify the findings of Caggiati (1999) and Kachlík et al (2008 a ) on the existence and arrangement of a perivenous connective tissue compartment (thickness, ranging from 5 to 8 mm), which surrounds the whole stem of the HGSV.…”

“…The present study is one of only a few (Kachlík et al, 2003(Kachlík et al, , 2007(Kachlík et al, , 2008a(Kachlík et al, , 2008bLametschwandtner et al, 2004) to analyze the structure of the VV in the HGSV, which is frequently used as a coronary bypass graft and is therefore relevant for cardiac surgery.…”

Vascularization of the arteriovenous fistula wall and association with maturation outcomes

“…To illustrate the opposite scenario, significant irrigation of the hyperplastic intima, entire media, and thrombi is observed in patients with recurrent varices or vein thrombophlebitis as a pathophysiological reaction to hypoxia. 33 In the case of AVFs, we propose that the increased luminal area of the adventitial microvasculature occurred as a result of the higher flow and intraluminal pressure in the artery where these microvessels originate. 34 Importantly, we found a significant correlation between lower vascularization of the media in AVFs (both VVD and VVA) and maximal intimal thickness.…”