Glycocalyx Damage as the Primary Event in Endothelial Dysfunction Among Patients with Lower Extremity Varicose Veins: Therapeutic and Preventive Strategies

The lecture presents findings from studies on endothelial function and the glycocalyx, contemporary data on the significance of markers of endothelial dysfunction, and initial results from electron microscopy of the glycocalyx in the venous wall endothelium of patients with varicose veins in the lower extremities. Research conducted over the past two decades has consistently indicated that protecting the endothelium is essential for preventing thrombus formation and inhibiting the progression of venous-specific inflammation. The endothelial glycocalyx is a crucial structural component of the venous wall, mediating endothelial adaptation to various hemodynamic conditions while protecting the endothelium. In cases of varicose veins and chronic venous insufficiency, there is observable systemic damage and shedding of the endothelial glycocalyx. The loss of this protective layer exposes adhesive molecules on the endothelial surface, initiating a cascade of pathological events: leukocyte and platelet adhesion occur, leading to localized inflammation, disrupted barrier function, increased vascular permeability, and a significant reduction in antithrombotic potential. Therefore, damage to the endothelial glycocalyx is a key factor in the emergence of endothelial dysfunction in veins. The restoration of the glycocalyx is recognized as a promising therapeutic approach, not only for enhancing venous tone but also for providing pathogenetic treatment of chronic venous diseases. The lecture outlines methodologies for studying glycocalyx integrity and markers of endothelial dysfunction, as well as results on the effectiveness of comprehensive correction strategies using sulodexide in patients with varicose veins.