Abstract
Venous disease is a very common disease that affects millions of people worldwide. While some of the factors that cause the development of varicose veins are well understood, the aetiology of venous ulceration is poorly understood. It has been demonstrated that venous valve failure in the large veins is an important factor leading to the development of varicose veins, however whether similar valves exist in the very small superficial veins of the human leg, and what role these valves may have in venous disease, is unknown. Therefore, the purpose of this study is to:
1. Identify whether venous valves are present in the very small superficial veins of the human leg, and if they are present,
2. Describe the density, size distribution, morphology, and regional distribution of these microvenous valves in 'normal' cadaveric legs
3. Compare the 'normal' microvenous valves from cadaveric tissue with microvenous valves from pathologic legs with chronic venous disease, to answer the hypothesis that individuals that develop venous ulceration have fewer microvenous valves than the normal population.
In order to examine microvenous valves, two main methods have been utilised, E12 sheet plastination and vascular casting. These methods in combination provide valuable insights into the anatomy of microvenous channels, and allow examination and quantification of the venous valves.
Using several techniques, this study has shown that microvenous valves are present within the very small veins of the superficial tissue of the human leg. These microvalves have been shown to be most prevalent in the smallest of the veins, down to 18μm in diameter. Approximately 60% of the valves were found to be associated with tributaries. The gaiter region was demonstrated to contain the lowest number and density of microvenous valves, significantly less that the upper or mid calf regions. In addition, the gaiter region was found to have a much lower proportion of microvalves in the most superficial veins, when compared with the other regions examined.
Contrary to our hypothesis, the number and density of microvalves in venous diseased legs was not different to that of normal legs. Similarly, the size and regional distributions were also not different. However, the microvalves from the venous diseased legs were significantly stretched and incompetent, allowing retrograde flow from the large veins through to the dermal capillaries.
In conclusion, this study has shown that venous valves are present in the smallest of the superficial veins of the human leg, and that their density and distribution is not different between normal and venous diseased individuals. However, the microvalves from the diseased legs were incompetent and allowed retrograde flow. The role that these valves play in normal and pathological circulation is unclear, and warrants further examination.