The influence of age on valve disease in patients with varicose veins analysed by transmission electron microscopy and stereology.

BACKGROUND: The aim of this study was to investigate the influence of age on the ultrastructure of venous valve morphology in patients with C2 classified chronic venous disorders according to the CEAP classification. PATIENTS AND METHODS: The study population consisted of 16 consecutive patients with varicose veins (C2). The mean age was 49.8 years (30-66). The (pre-) terminal valve including the vessel wall was harvested within the proximal 2 centimetres of the great saphenous vein. The mean thickness (volume-to-surface ratio = V/S ratio) of elastin, collagen, endothelium and of the entire valve was determined. A blinded morphologist performed the examination by transmission electron microscopy and stereology. Analyses by Pearson's product moment correlation, Kendall's tau and Spearman's rank correlation were performed to investigate whether there is a correlation between age and the ultrastructural morphology. RESULTS: Stereological analysis of the valves demonstrated a mean V/S ratio (signifying a thickness estimation) for elastin of 0.87 µm3/µm2, for collagen of 18.0 µm3/µm2, for endothelium of 0.65 µm3/µm2, and for the entire valve of 25.2 µm³/µm². Statistical analyses showed no statistically significant correlation between age and the ultrastructural morphology in this patient group. CONCLUSIONS: The ultrastructural morphology of the venous valves in chronic venous disorders may not depend on age in patients presenting with C2 disease. This conclusion may or may not apply to all C classes as we investigated a homogenous group of patients with C2 limbs.

Venous injury in lumbar anterior spine surgery.

UNLABELLED: To assess the clinical and angiological outcome of venous injury in lumbar anterior spine surgery. DESIGN: Follow-up study. METHODS: During a seven-year time span 77 consecutive patients underwent lumbar anterior spine surgery. Of these patients three patients suffered two minor and two major vein injuries. In two cases this was a common iliac vein injury. The other two injuries were at the level of the junction of the iliac veins with the inferior vena cava. The injuries were repaired by direct suture and the patients were followed-up by an independent angiologist. RESULTS: The follow-up, done clinically and with duplex sonography, plethysmography and ankle pressures showed no sequelae from the venous injuries. CONCLUSIONS: Venous injuries following anterior spine surgery are rare and may have a good recovery. Preoperative informed consent is recommended.