Abstract
Veins are essentially tubes with valves that function as passive conduits for blood flow. Venous valve function ensures unidirectional flow, emptying of venous compartments, physiologic drainage, and flow of blood from the superficial to deep system. Normal valve closure also produces dynamic fracturing of the gravitational hydrostatic pressure and is essential for proper function of the peripheral muscle pumps. Chronic venous disease produces hemodynamic disturbances which result in the inability of valves, pumps, and conduits in the venous system to maintain a normal venous pressure and normal flow. These disturbances are primarily caused by venous reflux, obstruction, or a combination of both.
References
Lee BB, Nicolaides AN, Myers K, Meissner M, Kalodiki E, Allegra C, et al. Venous hemodynamic changes in lower limb venous disease: the UIP consensus according to scientific evidence. Int Angiol. 2016;35(3):236–352.
Franceschi C. Dynanamic fractionizing of hydrostatic pressure, closed and open shunts, vicarious varicose evolution: how these concepts made the treatment of varices evolve? Phlebologie. 2003;56(1):61–6.
Ludbrook J, Beale G. Femoral venous valves in relation to varicose veins. Lancet. 1962;1(7220):79–81.
Cockett FB. The pathology and treatment of venous ulcers of the leg. Br J Surg. 1955;43(179):260–78.
Franceschi C, Zamboni P. Principles of venous hemodynamics. New York: Nova Science Publishers; 2009.
Bollinger A, Wirth W, Brunner U. Valve agenesis and dysplasia of leg veins. Morphological and functional studies. Schweiz Med Wochenschr. 1971;101(37):1348–53.
Stranden E. Dynamic leg volume changes when sitting in a locked and free floating tilt office chair. Ergonomics. 2000;43(3):421–33.
Ludbrook J. The musculovenous pumps of the human lower limb. Am Heart J. 1966;71(5):635–41.
Gardner AM, Fox RH. The venous pump of the human foot—preliminary report. Bristol Med Chir J. 1983;98(367):109–12.
Uhl JF, Gillot C. Anatomy of the foot venous pump: physiology and influence on chronic venous disease. Phlebology. 2009;27(5):219–30.
Scurr JH, Smith PC. The muscular pump of the foot: physiological and clinical importance. Phlebologie. 1993;46(2):209–15.
Kuster G, Lofgren EP, Hollinshead WH. Anatomy of the veins of the foot. Surg Gynecol Obstet. 1968;127(4):817–23.
Beaconsfield P, Ginsburg J. Effect of changes in limb posture on peripheral blood flow. Circ Res. 1955;3(5):478–82.
Mellander S, Oberg B, Odelram H. Vascular adjustments to increased transmural pressure in cat and man with special reference to shifts in capillary fluid transfer. Acta Physiol Scand. 1964;61:34–48.
Henriksen O. Local reflex in microcirculation in human subcutaneous tissue. Acta Physiol Scand. 1976;97(4):447–56.
Pollack AA, Wood EH. Venous pressure in the saphenous vein at the ankle in man during exercise and changes in posture. J Appl Physiol. 1949;1(9):649–62.
Hjelmstedt A. The pressure in the veins of the dorsum of the foot in quiet standing and during exercise in limbs without signs of venous disorder. Acta Chir Scand. 1968;134(3):235–44.
Hjelmstedt A. Pressure decrease in the dorsal pedal veins on walking in persons with and without thrombosis. A study of a fracture series. Acta Chir Scand. 1968;134(7):531–9.
Nicolaides AN, Zukowski AJ. The value of dynamic venous pressure measurements. World J Surg. 1986;10(6):919–24.
Kakkar V. The diagnosis of deep vein thrombosis using the 125 I fibrinogen test. Arch Surg. 1972;104(2):152–9.
Deweese JA, Rogoff SM. Phlebographic patterns of acute deep venous thrombosis of the leg. Surgery. 1963;53:99–108.
Sakaguchi S, Ishitobi K, Kameda T. Functional segmental plethysmography with mercury strain gauge. Angiology. 1972;23(3):127–35.
Dahn I, Eiriksson E. Plethysmographic diagnosis of deep venous thrombosis of the leg. Acta Chir Scand Suppl. 1968;398:33–42.
Gothlin J, Hallbook T. Plethysmography and phlebography in the diagnosis of acute deep venous thrombosis. Radiology. 1971;11(4):137–47.
Barnes RW, Collicott PE, Mozersky DJ, Summer DS, Strandness DE Jr. Noninvasive quantitation of maximum venous outflow in acute thrombophlebitis. Surgery. 1972;72(6):971–9.
Barnes RW, Hokanson DE, Wu KK, Hoak JC. Detection of deep vein thrombosis with an automatic electrically calibrated strain gauge plethysmograph. Surgery. 1977;82(2):219–23.
Bygdeman S, Aschberg S, Hindmarsh T. Venous plethysmography in the diagnosis of chronic venous insufficiency. Acta Chir Scand. 1971;137(5):423–8.
Christopoulos D, Tachtsi M, Pitoulias G, Belcaro G, Papadimitriou D. Hemodynamic follow-up of iliofemoral venous thrombosis. Int Angiol. 2009;28(5):394–9.
Zsoter T, Cronin RF. Venous distensibility in patients with varicose veins. Can Med Assoc J. 1966;94(25):1293–7.
Clarke H, Smith SR, Vasdekis SN, Hobbs JT, Nicolaides AN. Role of venous elasticity in the development of varicose veins. Br J Surg. 1989;76(6):577–80.
Travers JP, Brookes CE, Evans J, Baker DM, Kent C, Makin GS, et al. Assessment of wall structure and composition of varicose veins with reference to collagen, elastin and smooth muscle content. Eur J Vasc Endovasc Surg. 1996;11(2):230–7.
Wali MA, Eid RA. Changes of elastic and collagen fibers in varicose veins. Int Angiol. 2002;21(4):337–43.
Jacob MP, Badier-Commander C, Fontaine V, Benazzoug Y, Feldman L, Michel JB. Extracellular matrix remodeling in the vascular wall. Pathol Biol (Paris). 2001;49(4):326–32.
Rutherford RB. Varicose veins. In: Cronenwett JL, Rutherford RB, editors. Decision making in vascular surgery. Philadelphia: W. B. Saunders Co.; 2001. p. 290–3.
Gupta A, McCarthy S. Pelvic varices as a cause for pelvic pain: MRI appearance. Magn Reson Imaging. 1994;12(4):679–81.
Lechter A, Alvarez A, Lopez G. Pelvic varices and gonadal veins. Phlebology. 1987;2:181–8.
Cordts PR, Eclavea A, Buckley PJ, DeMaioribus CA, Cockerill ML, Yeager TD. Pelvic congestion syndrome: early clinical results after transcatheter ovarian vein embolization. J Vasc Surg. 1998;28(5):862–8.
Scultetus AH, Villavicencio JL, Gillespie DL, Kao TC, Rich NM. The pelvic venous syndromes: analysis of our experience with 57 patients. J Vasc Surg. 2002;36(5):881–8.
Badier-Commander C, Couvelard A, Henin D, Verbeuren T, Michel JB, Jacob MP. Smooth muscle cell modulation and cytokine overproduction in varicose veins. An in situ study. J Pathol. 2001;193(3):398–407.
Sansilvestri-Morel P, Rupin A, Jaisson S, Fabiani JN, Verbeuren TJ, Vanhoutte PM. Synthesis of collagen is dysregulated in cultured fibroblasts derived from skin of subjects with varicose veins as it is in venous smooth muscle cells. Circulation. 2002;106(4):479–83.
Bergan JJ, Schmid-Schonbein GW, Takase S. Therapeutic approach to chronic venous insufficiency and its complications: place of Daflon 500 mg. Angiology. 2001;52(Suppl 1):S43–7.
Michiels C, Bouaziz N, Remacle J. Role of the endothelium and blood stasis in the appearance of varicose veins. Int Angiol. 2002;21(1):1–8.
Weber C. Novel mechanistic concepts for the control of leukocyte transmigration: specialization of integrins, chemokines, and junctional molecules. J Mol Med. 2003;81(1):4–19.
Bergan JJ, Schmid-Schonbein GW, Smith PD, Nicolaides AN, Boisseau MR, Eklof B. Chronic venous disease. N Engl J Med. 2006;355(5):488–98.
Ono T, Bergan JJ, Schmid-Schonbein GW, Takase S. Monocyte infiltration into venous valves. J Vasc Surg. 1998;27(1):158–66.
Takase S, Schmid-Schonbein G, Bergan JJ. Leukocyte activation in patients with venous insufficiency. J Vasc Surg. 1999;30(1):148–56.
Takase S, Bergan JJ, Schmid-Schonbein G. Expression of adhesion molecules and cytokines on saphenous veins in chronic venous insufficiency. Ann Vasc Surg. 2000;14(5):427–35.
Xiao Y, Huang Z, Yin H, Lin Y, Wang S. In vitro differences between smooth muscle cells derived from varicose veins and normal veins. J Vasc Surg. 2009;50(5):1149–54.
Badier-Commander C, Verbeuren T, Lebard C, Michel JB, Jacob MP. Increased TIMP/MMP ratio in varicose veins: a possible explanation for extracellular matrix accumulation. J Pathol. 2000;192(1):105–12.
Leu AJ, Leu HJ, Franzeck UK, Bollinger A. Microvascular changes in chronic venous insufficiency--a review. Cardiovasc Surg. 1995;3(3):237–45.
Gemmati D, Federici F, Catozzi L, Gianesini S, Tacconi G, Scapoli GL, et al. DNA-array of gene variants in venous leg ulcers: detection of prognostic indicators. J Vasc Surg. 2009;50(6):1444–51.
Tassiopoulos AK, Golts E, Oh DS, Labropoulos N. Current concepts in chronic venous ulceration. Eur J Vasc Endovasc Surg. 2000;20(3):227–32.
Morano JU, Raju S. Chronic venous insufficiency: assessment with descending venography. Radiology. 1990;174(2):441–4.
Plate G, Brudin L, Eklof B, Jensen R, Ohlin P. Congenital vein valve aplasia. World J Surg. 1986;10(6):929–34.
Killewich LA, Bedford GR, Beach KW, Strandness DE Jr. Spontaneous lysis of deep venous thrombi: rate and outcome. J Vasc Surg. 1989;9(1):89–97.
Markel A, Manzo RA, Bergelin RO, Strandness DE Jr. Valvular reflux after deep vein thrombosis: incidence and time of occurrence. J Vasc Surg. 1992;15(2):377–82. discussion 383-4
O’Shaughnessy AM, Fitzgerald DE. Natural history of proximal deep vein thrombosis assessed by duplex ultrasound. Int Angiol. 1997;16(1):45–9.
Elsharawy M, Elzayat E. Early results of thrombolysis vs. anticoagulation in iliofemoral venous thrombosis. A randomised clinical trial. Eur J Vasc Endovasc Surg. 2002;24(3):209–14.
Saha P, Humphries J, Modarai B, Mattock K, Waltham M, Evans CE, et al. Leukocytes and the natural history of deep vein thrombosis: current concepts and future directions. Arterioscler Thromb Vasc Biol. 2011;31(3):506–12.
Wakefield TW, Myers DD, Henke PK. Mechanisms of venous thrombosis and resolution. Arterioscler Thromb Vasc Biol. 2008;28(3):387–91.
May R, Thurner J. The cause of the predominantly sinistral occurrence of thrombosis of the pelvic veins. Angiology. 1957;8(5):419–27.
Cockett FB, Thomas ML. The iliac compression syndrome. Br J Surg. 1965;52(10):816–21.
Gullmo A. The strain obstruction syndrome of the femoral vein. Acta Radiol. 1957;47(2):119–37.
Browse NL, Burnand KG, Thomas ML. Diseases of the veins. Pathology, diagnosis and treatment. London: Hodder and Stoughton; 1988.
Neglen P, Thrasher TL, Raju S. Venous outflow obstruction: an underestimated contributor to chronic venous disease. J Vasc Surg. 2003;38(5):879–85.
Gloviczki P, Stanson AW, Stickler GB, Johnson CM, Toomey BJ, Meland NB, et al. Klippel-Trenaunay syndrome: the risks and benefits of vascular interventions. Surgery. 1991;110(3):469–79.
Bates DO, Curry FE. Vascular endothelial growth factor increases hydraulic conductivity of isolated perfused microvessels. Am J Phys. 1996;271(6 Pt 2):H2520–8.
Bollinger A, Leu AJ, Hoffmann U, Franzeck UK. Microvascular changes in venous disease: an update. Angiology. 1997;48(1):27–32.
Mortimer PS. Evaluation of lymphatic function: abnormal lymph drainage in venous disease. Int Angiol. 1995;14(3 Suppl 1):32–5.
Partsch H, Mostbeck A. Involvement of the lymphatic system in postthrombotic syndrome. Wien Med Wochenschr. 1994;144(10–11):210–3.
Johnson BF, Manzo RA, Bergelin RO, Strandness DE Jr. Relationship between changes in the deep venous system and the development of the postthrombotic syndrome after an acute episode of lower limb deep vein thrombosis: a one- to six-year follow-up. J Vasc Surg. 1995;21(2):307–12. discussion 313
Strandness DE Jr, Langlois Y, Cramer M, Randlett A, Thiele BL. Long-term sequelae of acute venous thrombosis. J Am Med Assoc. 1983;250(10):1289–92.
Lindner DJ, Edwards JM, Phinney ES, Taylor LM Jr, Porter JM. Long-term hemodynamic and clinical sequelae of lower extremity deep vein thrombosis. J Vasc Surg. 1986;4(5):436–42.
Norris CS, Darrow JM. Hemodynamic indicators of postthrombotic sequelae. Arch Surg. 1986;121(7):765–8.
Akesson H, Brudin L, Dahlstrom JA, Eklof B, Ohlin P, Plate G. Venous function assessed during a 5 year period after acute ilio-femoral venous thrombosis treated with anticoagulation. Eur J Vasc Surg. 1990;4(1):43–8.
Heldal M, Seem E, Sandset PM, Abildgaard U. Deep vein thrombosis: a 7-year follow-up study. J Intern Med. 1993;234(1):71–5.
Milne AA, Stonebridge PA, Bradbury AW, Ruckley CV. Venous function and clinical outcome following deep vein thrombosis. Br J Surg. 1994;81(6):847–9.
Milne AA, Ruckley CV. The clinical course of patients following extensive deep venous thrombosis. Eur J Vasc Surg. 1994;8(1):56–9.
van Ramshorst B, van Bemmelen PS, Hoeneveld H, Eikelboom BC. The development of valvular incompetence after deep vein thrombosis: a follow-up study with duplex scanning. J Vasc Surg. 1994;19(6):1059–66.
van Haarst EP, Liasis N, van Ramshorst B, Moll FL. The development of valvular incompetence after deep vein thrombosis: a 7 year follow-up study with duplex scanning. Eur J Vasc Endovasc Surg. 1996;12(3):295–9.
Labropoulos N, Leon M, Nicolaides AN, Sowade O, Volteas N, Ortega F, et al. Venous reflux in patients with previous deep venous thrombosis: correlation with ulceration and other symptoms. J Vasc Surg. 1994;20(1):20–6.
Bradbury AW, MacKenzie RK, Burns P, Fegan C. Thrombophilia and chronic venous ulceration. Eur J Vasc Endovasc Surg. 2002;24(2):97–104.
Prandoni P, Lensing AW, Cogo A, Cuppini S, Villalta S, Carta M, et al. The long-term clinical course of acute deep venous thrombosis. Ann Intern Med. 1996;125(1):1–7.
Mackenzie RK, Ludlam CA, Ruckley CV, Allan PL, Burns P, Bradbury AW. The prevalence of thrombophilia in patients with chronic venous leg ulceration. J Vasc Surg. 2002;35(4):718–22.
Sam RC, Burns PJ, Hobbs SD, Marshall T, Wilmink AB, Silverman SH, et al. The prevalence of hyperhomocysteinemia, methylene tetrahydrofolate reductase C677T mutation, and vitamin B12 and folate deficiency in patients with chronic venous insufficiency. J Vasc Surg. 2003;38(5):904–8.
Brandjes DP, Buller HR, Heijboer H, Huisman MV, de Rijk M, Jagt H, et al. Randomised trial of effect of compression stockings in patients with symptomatic proximal-vein thrombosis. Lancet. 1997;349(9054):759–62.
Kahn SR. The post thrombotic syndrome. Thromb Res. 2011;127(Suppl 3):S89–92.
Shiman MI, Pieper B, Templin TN, Birk TJ, Patel AR, Kirsner RS. Venous ulcers: a reappraisal analyzing the effects of neuropathy, muscle involvement, and range of motion upon gait and calf muscle function. Wound Repair Regen. 2009;17(2):147–52.
Davies JA, Bull RH, Farrelly IJ, Wakelin MJ. A home-based exercise programme improves ankle range of motion in long-term venous ulcer patients. Phlebology. 2007;22(2):86–9.
Danielsson G, Eklof B, Grandinetti A, Kistner RL. The influence of obesity on chronic venous disease. Vasc Endovasc Surg. 2002;36(4):271–6.
Trendelenburg F. Über die Unterbindug der V. saphena magna bei Untersschenkelvarizen. Beitr Klin Chir. 1891;7:195–210.
Bjordal R. Simultaneous pressure and flow recordings in varicose veins of the lower extremity. A haemodynamic study of venous dysfunction. Acta Chir Scand. 1970;136(4):309–17.
Al-Mulhim AS, El-Hoseiny H, Al-Mulhim FM, Bayameen O, Sami MM, Abdulaziz K, et al. Surgical correction of main stem reflux in the superficial venous system: does it improve the blood flow of incompetent perforating veins? World J Surg. 2003;27(7):793–6.
Darke SG, Penfold C. Venous ulceration and saphenous ligation. Eur J Vasc Surg. 1992;6(1):4–9.
Lees TA, Lambert D. Patterns of venous reflux in limbs with skin changes associated with chronic venous insufficiency. Br J Surg. 1993;80(6):725–8.
Myers KA, Ziegenbein RW, Zeng GH, Matthews PG. Duplex ultrasonography for chronic venous disease: patterns of venous reflux. J Vasc Surg. 1995;21(4):605–12.
Christopoulos D, Nicolaides AN, Szendro G. Venous reflux: quantification and correlation with the clinical severity of chronic venous disease. Br J Surg. 1988;75(4):352–6.
Delis KT, Ibegbuna V, Nicolaides AN, Lauro A, Hafez H. Prevalence and distribution of incompetent perforating veins in chronic venous insufficiency. J Vasc Surg. 1998;28(5):815–25.
Zukowski AJ, Nicolaides AN, Szendro G, Irvine A, Lewis R, Malouf GM, et al. Haemodynamic significance of incompetent calf perforating veins. Br J Surg. 1991;78(5):625–9.
Stuart WP, Adam DJ, Allan PL, Ruckley CV, Bradbury AW. The relationship between the number, competence, and diameter of medial calf perforating veins and the clinical status in healthy subjects and patients with lower-limb venous disease. J Vasc Surg. 2000;32(1):138–43.
Stuart WP, Lee AJ, Allan PL, Ruckley CV, Bradbury AW. Most incompetent calf perforating veins are found in association with superficial venous reflux. J Vasc Surg. 2001;34(5):774–8.
Delis KT, Husmann M, Kalodiki E, Wolfe JH, Nicolaides AN. In situ hemodynamics of perforating veins in chronic venous insufficiency. J Vasc Surg. 2001;33(4):773–82.
Labropoulos N, Tiongson J, Pryor L, Tassiopoulos AK, Kang SS, Mansour MA, et al. Nonsaphenous superficial vein reflux. J Vasc Surg. 2001;34(5):872–7.
Chiu JJ, Chien S. Effects of disturbed flow on vascular endothelium: pathophysiological basis and clinical perspectives. Physiol Rev. 2011;91(1):327–87.
Nicolaides AN. Chronic venous disease and the leukocyte-endothelium interaction: from symptoms to ulceration. Angiology. 2005;56(Suppl 1):S11–9.
Pascarella L, Lulic D, Penn AH, Alsaigh T, Lee J, Shin H, Kapur V, Bergan JJ, Schmid-Schönbein GW. Mechanisms in experimental venous valve failure and their modification by Daflon 500 mg. Eur J Vasc Endovasc Surg. 2008;35(1):102–10.
Lattimer CR, Mendoza E. Superficial venous reflux duration and cessation with two concurrent duplex probes. J Vasc Surg Venous Lymphat Disord. 2015;3(1):154–60.
Lattimer CR, Azzam M, Kalodiki E, Geroulakos G. Quantifying saphenous recirculation in patients with primary lower extremity venous reflux. J Vasc Surg Venous Lymphat Disord. 2016;4(2):179–86.
Bjordal RI. Circulation patterns in incompetent perforating veins in the calf and in the saphenous system in primary varicose veins. Acta Chir Scand. 1972;138(3):251–61.
Bjordal RI. Blood circulation in varicose veins of the lower extremities. Angiology. 1972;23(3):163–73.
Folse R, Alexander RH. Directional flow detection for localizing venous valvular incompetency. Surgery. 1970;67(1):114–21.
Kianifard B, Holdstock J, Allen C, Smith C, Price B, Whiteley MS. Randomized clinical trial of the effect of adding subfascial endoscopic perforator surgery to standard great saphenous vein stripping. Br J Surg. 2007;94(9):1075–80.
Nelzen O, Fransson I. Early results from a randomized trial of saphenous surgery with or without subfascial endoscopic perforator surgery in patients with a venous ulcer. Br J Surg. 2011;98(4):495–500.
Nelzen O, Fransson I. True long-term healing and recurrence of venous leg ulcers following SEPS combined with superficial venous surgery: a prospective study. Eur J Vasc Endovasc Surg. 2007;34(5):605–12.
Perrin M, Ramelet AA. Pharmacological treatment of primary chronic venous disease: rationale, results and unanswered questions. Eur J Vasc Endovasc Surg. 2011;41(1):117–25.
Levick JR. An introduction to cardiovascular physiology. Oxford: Butterworth Heinemann Ltd; 1991.
Burnand KG, Whimster I, Naidoo A, Browse NL. Pericapillary fibrin in the ulcer-bearing skin of the leg: the cause of lipodermatosclerosis and venous ulceration. Br Med J (Clin Res Ed). 1982;285(6348):1071–2.
Cheatle TR, Sarin S, Coleridge Smith PD, Scurr JH. The pathogenesis of skin damage in venous disease: a review. Eur J Vasc Surg. 1991;5(2):115–23.
Coleridge Smith PD, Thomas P, Scurr JH, Dormandy JA. Causes of venous ulceration: a new hypothesis. Br Med J (Clin Res Ed). 1988;296(6638):1726–7.
Agren MS, Eaglstein WH, Ferguson MW, Harding KG, Moore K, Saarialho-Kere UK, et al. Causes and effects of the chronic inflammation in venous leg ulcers. Acta Derm Venereol Suppl (Stockh). 2000;210:3–17.
Schmid-Schonbein GW, Takase S, Bergan JJ. New advances in the understanding of the pathophysiology of chronic venous insufficiency. Angiology. 2001;52(Suppl 1):S27–34.
Rovenska E, Rovensky J. Lymphatic vessels: structure and function. Isr Med Assoc J. 2011;13(12):762–8.
Stanton AW, Patel HS, Levick JR, Mortimer PS. Increased dermal lymphatic density in the human leg compared with the forearm. Microvasc Res. 1999;57(3):320–8.
Olszewski WL, Engeset A. Intrinsic contractility of prenodal lymph vessels and lymph flow in human leg. Am J Phys. 1980;239(6):H775–83.
Tanaka H, Zaima N, Sasaki T, Yamamoto N, Sano M, Konno H, et al. Loss of lymphatic vessels and regional lipid accumulation is associated with great saphenous vein incompetence. J Vasc Surg. 2012;55(5):1440–8.
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Laredo, J., Lee, B.B. (2018). Venous Physiology and Pathophysiology. In: Chaar, C. (eds) Current Management of Venous Diseases . Springer, Cham. https://doi.org/10.1007/978-3-319-65226-9_2
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