하지 정맥류 혈관벽의 구조 및 구성 성분 변화에 대한 전자현미경학적 연구

손효성 ( Hyo Sung Son ),오창근 ( Chang Keun Oh ),이재봉 ( Jae Bong Lee ),김문범 ( Moon Bum Kim ),장호선 ( Ho Sun Jang ),권경술 ( Kyung Sool Kwon ) 대한피부과학회 2003 대한피부과학회지 Vol.41 No.7

N/A Background : Over the years many possible explanations for the development of varicose vein have been suggested. The main possible mechanisms are a valvular failure theory and a weak wall theory. However, the definite cause of varicose has not been determined yet. Objective : The aims of this study are to observe the pathologic changes in the smooth muscle cells and extracellular matrix of the primary varicose vein. An understanding of the pathology may possibly help to understand the pathogenesis of varicose veins. Methods : A total of 20 vein specimens of primary varicose vein were collected from 13 patients who underwent ambulatory phlebectomy. Among them, 16 specimens were thick segments and 4 specimens were thin segments of varicose veins. Control samples were collected from two patients with no history and clinical evidence of varicose vein. Each specimen was examined with a JEM 1200EX-Ⅱ electron microscopy. Ultrastructural findings between thick and thin segments of varicose veins and normal veins were also compared semiquantitatively. Results : The smooth muscle cells of varicose veins were abnormal in shape and lost their fusiform appearance with many vacuoles. Increased extracellular matrix shows the increase of degenerated collagen fibers and decrease of elastic fibers. Thick segments showed increased collagen fiber. Conclusion : These ultrastructural changes may be not the primary cause of varicose veins but the secondary remodeling processes of vein walls by hemodynamic stress. (Korean J Dermatol 2003;41(7) : 899~907)

일차성 하지 정맥류 혈관벽의 구조 및 구성 성분 변화에 관한 병리조직학적 연구

장봉석 ( Bong Seok Jang ),오창근 ( Chang Keun Oh ),이재봉 ( Jae Bong Lee ),김문범 ( Mun Bum Kim ),장호선 ( Ho Sun Jang ),권경술 ( Kyung Sool Kwon ) 대한피부과학회 2003 대한피부과학회지 Vol.41 No.7

N/A Background : Many factors have been implicated in the etiology of varicose veins. Among them, the most widely advanced are weakness of the vascular wall due to defective smooth muscle and connective tissue metabolism, dysfunction of the endothelium, valvular incompetence, and hemodynamic stress. However, the etiology remains unclear. Objective : This study was performed to analyze the wall structure and composition changes of primary varicose veins of the legs. Methods : Varicose vein samples were collected from 13 patients having primary varicose veins who underwent ambulatory phlebectomy. Control veins(below the age of 50 years) were collected from 2 patients with no history or clinical evidence of varicose vein. Samples were stained with hematoxylin and eosin, Masson`s Trichrome, Van Gieson stains and immunohistochemical stains for collagen type Ⅳ, α-smooth muscle actin antigen were performed. Tissue samples were examined by light microscopy for comparative histological changes and different components of the varicose vein wall as compared to control veins. Results : In the varicose vein, there was intimal hypertrophy in almost all the sections examined. The thickness of intima varied at different places. There were hyperplasia of smooth muscle cell and collagen in the varicose vein. Collagen type Ⅳ exhibited an accumulation especially in the subendothelial region of varicose vein. Conclusion : Dilatation and varicosities are not due to deficiency in the vein wall components, but rather to hemodynamic response, Modulation in the extracellular proteins may be the cause for the development of varices. (Korean J Dermatol 2003;41(7) : 873~880)

면역조직화학염색법을 이용한 정상 및 하지정맥류 환자의 대복재정맥벽에서의 Matrix Metalloproteinase 및 Tissue Inhibitor of Metalloproteinase의 발현도 분석

허승,권상휘,박태인,나목찬 대한혈관외과학회 2004 Vascular Specialist International Vol.20 No.1

하지 정맥류 환자에서 정맥류 혈관벽의 구조와 조성의 변화에 대한 분석

하태경,권오정,곽진영 대한혈관외과학회 2002 Vascular Specialist International Vol.18 No.1

Purpose: Valvular incompetence and venous wall abnormalities have been suggested as primary etiologic factors responible for the development of varicose veins. The valvular theory is known that the continuous gravitational pressure result in varicose vein. There are controversy about this theory. The collagen and elastic fiber have important role of maintaining structure and differentiation of vein. The authors reported on the factor affecting change of venous wall structure in varicose vein. Method: The present study describes the histopathologic aspects of varicose (n=10; mean age, 41.2 years) and normal saphenous veins (n=6 mean age, 55.3 years) of patients using H-E stain, Van-Gieson, Verhoeff stain, and thpe Ⅳ collagen immunohistochemical stain, and examined by light microcopy. Result: In H-E stain, venous wall distension, large amount smooth muscle cell, expansion of extracellular matrix, and a number of endothelial cells were seen. In Van-Gieson stain, the volume of smooth muscle cell increased especially in subendothelial layer and medial layer. The collagen increased in subendothelial and medial layer. The arrangement of smooth muscle cells was broken down due to infiltrations of collagen fiber between the smooth muscle cells. In Verhoeff stain, the elastic fiber was scatterd irregularly in the wall of varicose vein. The elastic fiber increased in small amount within intimal layer, but there was no significant change comparison to control group. In type Ⅳ collagen immunohistochemical stain, there was intense expression of type Ⅳ collagen gradually disappeared from medial layer close to adventitia. Conclusion: The compositions of collagen, elastic fiber, and smooth muscle cell in varicose vein may be different from that of vessel wall in normal vein in same level in the effect of same pressure. The results suggest that the etiology of varicose vein may depend on abnormal response of vessel wall from injury rather than valvular incompetence.

하지정맥류의 임상양상 - 227 수술예의 분석 -

최수승 대한흉부심장혈관외과학회 1999 Journal of Chest Surgery (J Chest Surg) Vol.32 No.11

Background: To know the clinical aspects of varicose vein and the effectiveness of operative treatment, the patients who had been operated during the five and a half years were reviewed. Material and Method: From September 1993 to February 1999, 227 patients with varicose vein were operated upon. These patients were reviewed with history taking, physical examination, laboratory tests, operation and follow up visits at an out patient department. Result: The ages of the patients were from 20 to 69 years, mean 40.2 years. varicose veins. Occupations of the patients include housewives, store or factory owners, cooks, waiter or waitresses in a restaurant, salary men(women), teachers, hair stylists, professional athletes, in sequence, most of them require standing all day long. The 126 women had experienced child birth, among them 116 patients delivered more than 2 babies. All patients had protruding leg veins as the symptom. Most of them(61%) had pain. Other additional symptoms were heaviness, heatness, tingling, cramp, fatigue, etc. 68.3% of the patients had the symptoms for more than 10 years. Anatomical location of varicose vein was in long saphenous vein in 157 patients, in small saphenous vein in 27, and in other regions(combined or perforating vein) in 43 patients. There was no operative mortality. There were 2 patients who underwent reoperation due to recurrence during this study period. In one patient, it recurred in the distal perforating vein in small saphenous vein. The other patient had recurrence at the saphenofemoral junction in groin. The patients are doing well after the reoperation, but a long term observation is needed. Conclusion: Clinical aspects of varicose vein were reviewed. For the patients with varicose vein who had saphenofemoral regurgitation, operative treatment seemed to bea safe and effective modality of treatment.

하지정맥류의 치료

조대윤 대한의사협회 2010 대한의사협회지 Vol.53 No.11

High venous pressure in leg from walking in erect position can lead the development of defective valves and reflux, and superficial veins may become elongated and tortuous. Women are more prone to varicose vein due to hormonal influences and pregnancy. Besides long standing occupation and female gender, there are other risk factors including age, family history, obesity, and prior deep vein thrombosis. Recently developed health related quality of life has contributed to concern more about varicose vein and develop the treatment modalities of varicose vein. Because of the chronicity of the development of varicose vein, most patients are usually accustomed to high venous pressure of their leg and feel minor or no discomfort. Among the reasons to seek for the treatment of varicose vein, cosmetic purpose is the most common. Most patients prefer non-surgical treatment including sclerotheraphy to surgical intervention. High ligation and stripping of varicose vein has remained as the standard treatment of varicose vein with excellent long term results. Minimal invasive non-surgical treatments including radiofrequency ablation and endovenous laser treatment have shown less scars and earlier mobility. Newer treatment modalities have to prove comparable long term results, not merely better cosmetic and short term results. We reviewed about the development of varicose vein and the treatment modalities including preventive measures. Correct comprehension of the patient and proper application of the treatment modality are essential for the good result without recurrence after the treatment of varicose vein.

Fire Acupuncture for Varicose Veins in the Lower Extremities: A Review of Randomized Controlled Trials

조온유,Jiyoon Lee,Sangmin Park,Jaewook Shin,Saerom Choi,Seongyong Choi 대한침구의학회 2023 대한침구의학회지 Vol.40 No.3

Varicose veins have a substantial burden on individuals’ aesthetics and overall quality of life. The current body of research on Korean medical interventions for varicose veins is limited in Korea, and exploration into clinical trends is lacking. This review specifically analyzed fire acupuncture, which is an understudied intervention in Korea that demonstrated efficacy in alleviating pain and paralysis while promoting tissue regeneration. A comprehensive investigation of the China National Knowledge Infrastructure database was conducted, utilizing terms such as “varicose vein,” “fire needle,” “fire acupuncture,” “burning acupuncture,” “burning needle,” “huǒzhēn,” “xiàzhī jìngmài,” and “jìngmài qūzhāng.” This review included 14 studies investigating the role of fire acupuncture in treating varicose veins. We extracted variables, including age, sex, disease duration, intervention method, treatment frequency, treatment period, acupoints, and outcomes. Fire acupuncture appeared as the primary intervention method, followed by general acupuncture. The protruding part of varicose veins is the main treatment area for fire acupuncture, while the acupoints BL57 and ST36 were most frequently utilized for general acupuncture. Treatment results revealed significant improvement in all studies. However, there are limitations, such as scarce studies, limited side effects studies, and potential bias. Consequently, extensive and well-structured future studies are necessary to demonstrate the role of fire acupuncture in varicose veins.

하지정맥류 치료를 위한 경화요법의 경험

김찬우,박대환,안기영,한동길,박기혁 대한성형외과학회 2002 Archives of Plastic Surgery Vol.29 No.4

Sclerotherapy has been demonstrated as an effective and minimally invasive procedure for varicose veins of the lower limbs, which can be performed on an out-patient basis. Between March 2000 and August 2001, we reviewed 138 patients who had been diagnosed as chronic venous disease in our hospital, and treated and evaluated a total of 32 limbs in 21 patients with primary varicose veins. There were 18 women and 3 men whose age was ranging from 31 to 55 years old, with a mean of 41.7 years. Eleven of 21 patients had bilateral involvement of lower extremity. Sclerodex(Sclerosant) was administered for telangiectasia less than 1mm and reticular vein less than 4mm, and Thromboject(Sodium Tetradecyl Sulfate) was for reticular vein more than 4mm. Two types of operations were stripping of saphenous vein (6 cases) and high ligation (18 cases). All patients were cosmetically satisfied with the results. Minor complications after injection such as 7 cases (21.9%) of erythema, 5 cases(15.6%)of bullae, 4 cases (12.5%)of thrombosis were occurred. However, no permanent change such as skin necrosis and pigmentation were appeared. Systemic responses such as dizziness or sweating were not observed in anyone. Sclerotherapy should improve both the safety and efficacy of the treatment of varicose vein. Our study suggests that the careful evaluation before planning the treatment of varicose vein is important for exact choice of patients and proper results.

A Study on the Implementation of Ultrasonic Guidance Algorithm for Improving Safety of Ultrasonic Varicose Vein Treatment

Seong-Cheol Kim(김성철),Ju-Young Kim(김주영),Si-Cheol Noh(노시철),Heung-Ho Choi(최흥호) 한국방사선학회 2018 한국방사선학회 논문지 Vol.12 No.3

In this study, we performed to design an image guiding algorithm to improve the efficiency and safety of treatment of varicose vein by focused ultrasound. The algorithm was suggested by different guiding images according to the location of varicose veins. In the case of deep-seated varicose veins, the target area was marked on the surface of the blood vessel in the obtained cross-sectional blood vessel ultrasound image. In the case of the superficial varicose vein, A guiding system based on image segmentation algorithm of the vascular region was suggested and designed two different algorithms according to varicose veins progression degree. as a results, the algorithm based on ultrasound image show a small error with 830 ㎛ at maximum. However, the algorithm based on charge coupled device image has a maximum error of 8.3 mm in some data. Therefore, it is expected that additional study is needed for superficial varicose vein image guiding algorithm, and it is expected that the accuracy of blood vessel tracking should be evaluated by constructing simple system. 본 연구에서는 집속초음파에 의한 하지정맥류 치료에서 치료의 효율과 안전성을 높이기 위한 영상유도 알고리즘을 제안하고자 하였다. 하지정맥류가 발생한 위치에 따라 영상 유도 기법을 달리하여 알고리즘을 수립하였다. 심부성 하지정맥류의 경우는 획득된 초음파영상에서 혈관의 가로 단면 영상을 추출하고 혈관 중심부의 목표영역을 표시하도록 하였으며, 표재성 하지정맥류의 경우에는 인체의 표재정맥에서 획득한 CCD 카메라 영상에서 혈관 영역을 분리한 영상을 기반으로 한 영상 유도 시스템을 제작하고 하지정맥류 진행 정도에 따라 각기 다른 알고리즘을 설계 하였다. 실험결과 초음파 영상 기반의 알고리즘은 전체적으로 최대 830㎛ 정도의 낮은 오차를 보였으나 CCD 영상 기반의 알고리즘은 일부 데이터에서 최대 8.3mm 정도의 오차를 보였다. 이에 표재성 하지정맥류 영상 유도 알고리즘에 대해서는 추가적인 연구가 필요할 것으로 예상되며 이후 간단한 시스템을 구성함으로써 혈관 추적의 정확도를 평가할 필요성이 있을 것으로 예상된다.

원발성 하지정맥류의 압박경화요법

이석열,양성린,이길노 순천향의학연구소 2001 Journal of Soonchunhyang Medical Science Vol.7 No.1

Background: Varicose veins are a very common condition that presents in a variety of forms. Treatment mordlities are variant and beneficial. The authors report an experience of compression sclerotherapy using Tromboject(Sodium tetradecyl sulfate) in varicose veins of the lower extremities. Methods: Prospective study was performed in 62 varicose vein patients who were treated with compression sclerotherapy from Mar. 1999 to Mar 2001. Sclerosing agent was used by 1%, 3% sodium tetradecyl sulfate and high concentrated agent was injected in proportion to vessel diameter. And then the patients wore compression stocking for 2 months. Results: The prevalent age group consisted of fourth decade and mean age was 39. The female to male ratio was 3.8:1. The site of varicose vein was similar to both side and major involved vein was greater saphenous vein. Duration of the varicose vein was mostly 1-20 years. All patients were complained of cosmetic problem and other symtoms were heaviness, walking discomfort, pain and leg edema. The most etiologic factor was pregnancy. Average frequency of injection was 1.65±0.55 and mean follow-up periods was 11.9 months. There was no recurrence during follow-up periods. The most patients were satisfied with compression sclerotherapy and satisfaction degree was 4.84±0.42. Hyperpigmentation was developed in all case but normalized after 3-6 months. Other complications was leg edema, superficial thrombophlebitis, and hematoma. Contact dermatitis appeared as complication ,especially summer, due to compression stocking. Conclusion: Compression sclerotherapy showed good results and minimal side effects in varicose vein of the lower extremities. Compression sclerotherapy may be primary treatment in selected cases.