Significant features characterizing the nature of varicose vein disease

Abstract

The following features characterize varicose vein disease: 1) Venous reflux, 2) Inherent weakness of the vein wall, 3) Tendency to recurrence. Venous reflux is the most important pathological hemodynamic phenomenon causing ambulatory venous hypertension and evoking chronic venous insufficiency; it is released by the ambulatory pressure gradient, which arises during calf pump activity between thigh and lower leg veins. Inherent weakness of the vein wall entails increased vein distensibility. The impaired vein wall structure is not able to resist the dilatation force of the hydrostatic and intra-abdominal pressure; the veins in the lower extremity subsequently dilate, become incompetent, and tend to form varicose veins. Abolition of saphenous reflux removes the hemodynamic disturbance but it simultaneously generates preconditions for reflux recurrence. This run of events is triggered by the drainage of venous blood from the thigh saphenous system into deep lower leg veins, which occurs during calf pump activity. The dividing line of the ambulatory pressure gradient that is located in healthy people just below the knee joint is displaced into the thigh between the femoral vein and the incompetent thigh saphenous system; in this way, pressure gradient between the femoral vein and the incompetent saphenous system occurs and starts the chain of events that evokes reflux recurrence. Hindrance of the untoward drainage at the knee level would prevent generation of this prerequisite for reflux recurrence.