Phlebosclerosis

PHLEBOSCLEROSIS, sclerosis of a vein, is a concept encompassing all cases of connective tissue proliferation in the venous wall in any of its layers. The etiology and pathogenesis of phlebosclerosis can be extremely diverse. Phlebosclerosis may be the result of hypertrophy of the venous wall on the basis of prolonged venous hyperemia. Phlebosclerosis may result from senile atrophy of the muscular part of the venous wall with its subsequent replacement by connective tissue. Often, phlebosclerosis is the result of phlebitis, and among inflammatory phleboscleroses, according to literature data, those associated with syphilitic infection predominate. Phlebosclerosis may be of traumatic origin: bruises, tears of the venous wall with subsequent scarring. Phlebosclerosis is often associated with thrombosis, being either a consequence of thrombosis and developing along the course of thrombus organization, or preceding thrombosis, which further enhances phlebosclerosis. A fundamental issue in the doctrine of phlebosclerosis is whether any variety of phlebosclerosis exists that would be analogous to atherosclerosis as a general disease and what the relationship is between phlebosclerosis and arterial atherosclerosis. At the present time, this question must be answered in the negative. We know of no general phlebosclerosis that is analogous to general atherosclerosis, either from a pathogenetic, morphological, or clinical standpoint. That phlebosclerosis with fatty degeneration and even calcification, which is observed extremely rarely in the portal vein system, has fundamentally nothing in common with atherosclerosis. This variety of phlebosclerosis is a local disease associated with some other process, most often with syphilis, and therefore is not related to a primary disturbance of lipid metabolism. The lipid infiltration and calcification observed in this condition represent a local process of a dystrophic order. Morphological diagnosis of phlebosclerosis presents no difficulties, especially if special staining for connective tissue of the Van Gieson type has been used. The clinical significance of phlebosclerosis is determined by its localization and the extent of the lesion. Phlebosclerosis is a serious precondition for thrombosis. Injuries to sclerosed veins present a great danger in terms of subsequent hemorrhage.