ORIGINAL ARTICLES   

International Angiology 2003 March;22(1):43-9

Copyright © 2003 EDIZIONI MINERVA MEDICA

lingua: Inglese

Increased mast cell infiltration in familial varicose veins: pathogenetic implications?

Kakkos S. K. ^{1, 2}, Zolota V. G. ¹, Peristeropoulou P. ¹, Apostolopoulou A. ¹, Geroukalos G. ², Tsolakis A. ¹

¹ University of Patras Medical School, Patras, Greece 2 Department of Vascular Surgery, Faculty of Medicine, Imperial College, St. Mary’s Hospital, London, UK

Aim. ­Increased infil­tra­tion of acti­vat­ed mast cells has been recent­ly impli­cat­ed in the pathoph­y­sio­lo­gy of var­i­cose veins. The aim of the ­present study was to inves­ti­gate a pos­sible asso­ci­a­tion ­between mast cell infil­tra­tion of pri­mary var­i­cose veins and clin­i­cal fea­tures, which could clar­i­fy fur­ther var­i­cose vein pathoph­y­sio­lo­gy.
Meth­ods. Sev­en­teen ­patients, oper­at­ed on for pri­mary var­i­cose veins and great­er saph­e­nous vein incom­pe­tence, par­tic­i­pat­ed in the study. Mast cells, dis­trib­ut­ed with­in the adven­ti­tia of gross­ly abnor­mal seg­ments of the great­er saph­e­nous vein and calf var­i­cos­ities ­removed dur­ing sur­gery, were iden­ti­fied and meas­ured in ­stained tis­sue sec­tions. The mast cell count, ­expressed as mast cells per 10 high-power ­fields, was sub­se­quent­ly asso­ciat­ed with clin­i­cal fea­tures, includ­ing age, gen­der, body mass index, famil­ial var­i­cose veins, dura­tion of var­i­cose vein dis­ease and rela­tion to pre­vi­ous preg­nan­cies, leg symp­toms and find­ings on phys­i­cal exam­ina­tion, clin­i­cal class and score of chron­ic ­venous insuf­fi­cien­cy (CEAP clas­sifi­ca­tion).
­Results. ­Patients with fam­i­ly his­to­ry of var­i­cose veins (n=7) had a sig­nif­i­cant­ly ­increased mast cell infil­tra­tion (­median, inter­quar­tile range) of the abnor­mal ­venous seg­ments (16, 8.4) in com­par­i­son with those (n=10) with­out such a his­to­ry (9.2, 7.3), p=0.005. Mast cell infil­tra­tion had a sig­nif­i­cant ­inverse asso­ci­a­tion with age (r=-0.49, p=0.046), but not with the remain­ing clin­i­cal fea­tures.
Con­clu­sion. Our find­ings sup­port the hypoth­e­sis that the ­increased mast cell infil­tra­tion in var­i­cose veins is not a con­se­quence of ­venous hyper­ten­sion. Fur­ther­more, the ­increased mast cell infil­tra­tion in famil­ial var­i­cose veins ­implies a rath­er pri­mary role and there­fore the pres­ence of a dis­tinct pathoph­y­sio­lo­gy. Fur­ther inves­ti­ga­tion test­ing the activ­ity of mast cells in cases of fam­i­ly his­to­ry might ­reveal ­another step in the path­o­gen­ic mech­a­nism of var­i­cose veins, lead­ing to a more ration­al treat­ment.