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Angiology, Vol. 57, No. 5, 556-563 (2006)
DOI: 10.1177/0003319706293117

Conception of the Venous Hemodynamics in the Lower Extremity

C. Recek, MD

Vienna, Austria, recek{at}aon.at

Contradictory reports on the significance of several hemodynamic phenomena, such as femoral vein incompetence and incompetent calf perforators, impede orientation in venous hemodynamics. Venous pressure difference arising between the popliteal and the posterior tibial vein during the activity of the calf muscle venous pump was reported for the first time about 50 years ago, but regrettably, this important discovery continues to be unrespected. The venous pressure difference has since been termed ambulatory pressure gradient and seems to be the key factor triggering the venous reflux in the lower limb as well as the process leading to varicose vein recurrence. On the other hand, simultaneous recordings of the mean venous pressure in the posterior tibial and long saphenous veins demonstrated that the pressure curves have been identical at rest, during ambulation, and in the recovery period, a finding typical of conjoined vessels. Bidirectional flow within calf perforators taking place both in healthy subjects and in patients with varicose veins enables a quick equilibration of pressure changes between deep and superficial veins of the lower leg. Reflux disturbing the venous hemodynamics is in various degrees dependent on the quantity of retrograde flow; abolition of reflux restores normal venous hemodynamics. Reflux in superficial veins, if large enough, may cause the most severe form of chronic venous insufficiency. Femoral vein incompetence and incompetent calf perforators per se do not produce ambulatory venous hypertension and do not cause hemodynamic disturbance. This study discusses the controversial issues, tries to define and appraise the principal hemodynamic phenomena (ambulatory venous hypertension, ambulatory pressure gradient, venous reflux, superficial and deep vein incompetence, incompetent perforators), mentions a possible relation between deep vein incompetence and varicose veins, and attempts to present, based on proved facts, a comprehensive picture of the venous hemodynamics in the lower extremity.

References

  • Trendelenburg F: Über die Unterbindung der V. saphena magna bei Unterschenkelvarizen. Beitr Klin Chir 7: 195-210, 1891.
  • Bjordal R: Simultaneous pressure and flow recordings in varicose veins of the lower extremity. Acta Chir Scand 136: 309-317, 1970.[ISI][Medline] [Order article via Infotrieve]
  • Bjordal RJ: Circulation patterns in incompetent perforating veins in the calf and the saphenous system in primary varicose veins. Acta Chir Scand 138: 251-261, 1972.[ISI][Medline] [Order article via Infotrieve]
  • Höjensgard IC, Stürup H: Static and dynamic pressures in superficial and deep veins of the lower extremity in man. Acta Physiol Scand 27: 49-67, 1952.[ISI][Medline] [Order article via Infotrieve]
  • Arnoldi CC: Venous pressure in patients with valvular incompetence of the veins of the lower limb. Acta Chir Scand 132: 628-645, 1966.
  • Linton RR: The communicating veins of the lower leg and the operative technique for their ligation. Ann Surg 107: 582-593, 1938.[CrossRef][ISI][Medline] [Order article via Infotrieve]
  • Cockett FB, Jones EE: The ankle blow-out syndrome. A new approach to the varicose ulcer problem. Lancet 1: 17-23, 1953.[ISI][Medline] [Order article via Infotrieve]
  • Arnoldi CC: Venous pressure in the legs of healthy human subjects at rest and during muscular exercise in nearly erect position. Acta Chir Scand 130: 530-583, 1965.
  • Recek C, Pojer H: Ambulatory pressure gradient in the veins of the lower extremity. VASA 29: 187-190, 2000.[CrossRef][ISI][Medline] [Order article via Infotrieve]
  • Recek C: The venous reflux. Angiology 55: 541-548, 2004.[Abstract/Free Full Text]
  • Sarin S, Scurr JH, Coleridge Smith PD: Assessment of stripping the long saphenous vein in the treatment of primary varicose veins. Br J Surg 79: 889-893, 1992.[ISI][Medline] [Order article via Infotrieve]
  • Sarin S, Scurr JH, Coleridge Smith PD: Stripping of the long saphenous vein in the treatment of primary varicose veins. Br J Surg 81: 1455-1458, 1994.[ISI][Medline] [Order article via Infotrieve]
  • Recek C: Auswirkung der Krossektomie auf die venöse Hämodynamik bei primärer Varikose. Phlebologie 25: 11-18, 1996.
  • McMullin GM, Coleridge Smith PD, Scurr JH: Objective assessment of high ligation without stripping the long saphenous vein. Br J Surg 78: 1139-1142, 1991.[ISI][Medline] [Order article via Infotrieve]
  • Neglen P, Einarsson E, Eklof B: The functional long-term value of different types of treatment for saphenous vein incompetence. J Cardiovasc Surg (Torino) 34: 295-301, 1993.[Medline] [Order article via Infotrieve]
  • Ik Kim D, Boong Lee B, Bergan JJ: Venous hemodynamic changes after external banding valvuloplasty with varicosectomy in the treatment of primary varicose veins. J Cardiovasc Surg (Torino) 40: 567-570, 1999.[Medline] [Order article via Infotrieve]
  • Koyano K, Sacaguchi S: Selective stripping operation based on Doppler ultrasonic findings for primary varicose veins of the lower extremities. Surgery 103: 615-619, 1988.[ISI][Medline] [Order article via Infotrieve]
  • Christopoulos D, Nicolaides AN, Galloway JMD, et al: Objective noninvasive evaluation of venous surgical results. J Vasc Surg 8: 683-687, 1988.[CrossRef][ISI][Medline] [Order article via Infotrieve]
  • Christopoulos DG, Nicolaides AN, Szendro G, et al: Air-plethysmography and the effect of elastic compression on venous hemodynamics of the leg. J Vasc Surg 5: 148-159, 1987.[CrossRef][ISI][Medline] [Order article via Infotrieve]
  • Recek C: Saphena-Reflux als Ursache der venösen Zirkulationsstörung bei primärer Varikose mit chronischer Veneninsuffizienz. Acta Chir Austriaca 2: 76-77, 1998.
  • Fitridge RA, Dunlop C, Raptis S, et al: A prospective randomized trial evaluating the hemodynamic role of incompetent calf perforating veins. Austr NZ J Surg 69: 214-216, 1999.
  • Recek C, Karisch E, Gruber J: Veränderungen der Perforansvenen und tiefen Unterschenkelvenen nach Beseitigung des Saphena-Refluxes. Phlebologie 29: 37-40, 2000.
  • Stuart WP, Adam DJ, Allan PL, et al: Saphenous surgery does not correct perforator incompetence in the presence of deep vein reflux. J Vasc Surg 28: 834-838, 1998.[CrossRef][ISI][Medline] [Order article via Infotrieve]
  • Gooley NA, Summer DS: Relationship of the venous reflux to the site of venous valvular incompetence: Implications for venous reconstructive surgery. J Vasc Surg 7: 50-59, 1988.[CrossRef][ISI][Medline] [Order article via Infotrieve]
  • Pearce WH, Ricco JB, Queral LA, et al: Hemodynamic assessment of venous problems. Surgery 93: 715-721, 1983.[ISI][Medline] [Order article via Infotrieve]
  • Recek C, Hammerschlag A: Welche hämodynamische Bedeutung hat die Insuffizienz der V. femoralis und V. poplitea? Phlebologie 27: 15-18, 1998.
  • Shull KC, Nicolaides AN, Fernandes JF, et al: Significance of popliteal reflux in relation to ambulatory venous pressure and ulceration. Arch Surg 114: 1304-1306, 1979.[Abstract]
  • Kistner RL: Surgical repair of the incompetent fem-oral vein valve. Arch Surg 110: 1336-1342, 1975.[Abstract]
  • Raju S, Fredericks R: Valve reconstruction procedures for nonobstructive venous insufficiency: Rationale, techniques and results in 107 procedures with two-to eight-year follow-up. J Vasc Surg 7: 301-309, 1988.[CrossRef][ISI][Medline] [Order article via Infotrieve]
  • Welch HJ, McLaughlin RL, O’Donnell TF Jr: Femoral vein valvuloplasty: Intraoperative angioscopic evaluation and hemodynamic improvement. J Vasc Surg 16: 694-700, 1992.[CrossRef][ISI][Medline] [Order article via Infotrieve]
  • Wilson NM, Rutt DL, Browse NL: Repair and replacement of deep valves in the treatment of venous insufficiency. Br J Surg 78: 388-394, 1991.[ISI][Medline] [Order article via Infotrieve]
  • Taheri SA, Prendergast DR, Lazar E, et al: Vein valve transplantation. Am J Surg 150: 201-202, 1985.[CrossRef][ISI][Medline] [Order article via Infotrieve]
  • O’Donnell TF Jr, Mackey WC, Shepard AD, et al: Clinical, hemodynamic and anatomic follow up of direct venous reconstruction. Arch Surg 122: 474-481, 1987.[Abstract]
  • Jamieson WG, Chinnick B: Clinical results of deep venous valvular repair for chronic venous insufficiency. Can J Surg 40: 294-299, 1997.[ISI][Medline] [Order article via Infotrieve]
  • Bry JD, Muto PA, O’Donnell TF, et al: The clinical and hemodynamic results after axillary-to-popliteal vein valve transplantation. J Vasc Surg 21: 110-119, 1995.[CrossRef][ISI][Medline] [Order article via Infotrieve]
  • Eriksson I, Almgren B: Surgical reconstruction of incompetent deep vein valves. Ups J Med Sci 93: 139-143, 1988.[ISI][Medline] [Order article via Infotrieve]
  • Johnson ND, Queral LA, Flinn WR, et al: Late objective assessment of venous valve surgery. Arch Surg 116: 1461-1466, 1981.[Abstract]
  • Padberg FT Jr, Pappas PJ, Araki CT, et al: Hemodynamic and clinical improvement after superficial vein ablation in primary combined venous insufficiency with ulceration. J Vasc Surg 26: 169-171, 1997.[CrossRef][ISI][Medline] [Order article via Infotrieve]
  • Ting AC, Cheng SW, WU LL, et al: Changes in venous hemodynamics after superficial vein surgery for mixed superficial and deep venous insufficiency. World J Surg 25: 122-125, 2001.[CrossRef][ISI][Medline] [Order article via Infotrieve]
  • Ludbrook L, Beale G: Femoral venous valves in relation to varicose veins. Lancet 1/13: 79-81, 1962.
  • Hauser H, Brunner U: Neue pathophysiologische und funktionelle Gesichtspunkte zur Insuffizienz der Vena saphena parva. VASA 22: 338-341, 1993.[ISI][Medline] [Order article via Infotrieve]
  • Recek C, Hammerschlag A: Insuffizienz der femoropoplitealen Venenachse und Parva-Varikosis: Ein kausaler Zusammenhang? Phlebologie 26: 115-119, 1997.
  • Belcaro G, Nicolaides AN, Ricci A, et al: External femoral vein valvuloplasty with limited anterior plication (LAP): 10-year randomized, follow-up study. Angiology 50: 531-536, 1999.[ISI][Medline] [Order article via Infotrieve]
  • Makarova NP, Lurie F, Hmelniker SM: Does surgical correction of the superficial femoral vein valve change the course of varicose disease? J Vasc Surg 33: 361-368, 2001.[CrossRef][ISI][Medline] [Order article via Infotrieve]
  • Fischer R, Schwahn-Schreiber CH, Sattler G: Ergebnisse der Konsensuskonferenz über die subfasziale Endoskopie der Vv. perforantes des medialen Unterschenkels. Phlebologie 26: 60-65, 1997.
  • Gloviczki P, Bergan JJ, Rhodes JM, et al: Midterm results of endoscopic perforator vein interruption for chronic venous insufficiency: Lessons learned from the North American subfascial endoscopic perforator surgery registry. The North American Study Group. J Vasc Surg 29: 489-502, 1999.[CrossRef][ISI][Medline] [Order article via Infotrieve]
  • Hauer G, Bergan JJ, Werner A, et al: Development of endoscopic dissection of perforating veins and fasciotomy for treatment of chronic venous insufficiency. Ann Vasc Surg 13: 357-364, 1999.[CrossRef][ISI][Medline] [Order article via Infotrieve]
  • Nelzen O: Prospective study of safety, patient satisfaction and leg ulcer healing following saphenous and subfascial endoscopic perforator surgery. Br J Surg 87: 86-91, 2000.[CrossRef][ISI][Medline] [Order article via Infotrieve]
  • Rhodes JM, Glowiczki P, Canton L, et al: Endoscopic perforator vein division with ablation of superficial reflux improves venous hemodynamics. J Vasc Surg 28: 839-847, 1998.[CrossRef][ISI][Medline] [Order article via Infotrieve]
  • Illig KA, Shortell CK, Ouriel K, et al: Photoplethysmography and calf muscle pump function after subfascial endoscopic perforator ligation. J Vasc Surg 30: 1067-1076, 1999.[CrossRef][ISI][Medline] [Order article via Infotrieve]
  • Akeson H, Brudin L, Cwikiel W, et al: Does the correction of insufficient superficial and perforating veins improve venous function in patients with deep venous insufficiency? Phlebology 5: 113-123, 1990.
  • Burnand KG, O’Donnell JTF, Thomas ML, et al: The relative importance of incompetent communicating veins in the production of varicose veins and venous ulcers. Surgery 82: 9-13, 1977.[ISI][Medline] [Order article via Infotrieve]
  • Scriven JM, Bianchi V, Hartshorne T, et al: A clinical and haemodynamic investigation into the role of calf perforating vein surgery in patients with venous ulceration and deep venous incompetence. Eur J Vasc Endovasc Surg 16: 148-152, 1998.[CrossRef][ISI][Medline] [Order article via Infotrieve]
  • Recek C, Koudelka V: Effet circulatoire du reflux saphénien dans la varicose essentielle. Phlébologie 32: 407-414, 1979.[Medline] [Order article via Infotrieve]
  • Sarin S, Scurr JH, Coleridge Smith PD: Medial calf perforators in venous disease: The significance of outward flow. J Vasc Surg 16: 40-46, 1992.[CrossRef][ISI][Medline] [Order article via Infotrieve]
  • Recek C: Venöse Hämodynamik in den Beinen bei Gesunden und bei primärer Varikose. Phlebologie 30: 107-114, 2001.
  • Recek C: A critical appraisal of the role of ankle perforators for the genesis of venous ulcers in the lower leg. J Cardiovasc Surg (Torino) 12: 45-49, 1971.[Medline] [Order article via Infotrieve]
  • Corbett CR, Runcie IJ, Thomas ML, et al: Reasons to strip the long saphenous vein. Phlebologie 41: 766-769, 1988.[Medline] [Order article via Infotrieve]
  • Rutherford RB, Sawyer JD, Jones DN: The fate of residual saphenous vein after partial removal or ligation. J Vasc Surg 12: 422-428, 1990.[CrossRef][ISI][Medline] [Order article via Infotrieve]
  • Hammarsten J, Bernland P, Campanello M, et al: A study of the mechanism by which haemodynamic function improves following long saphenous vein-saving surgery. Phlebology 11: 102-105, 1996.
  • McMullin GM, Coleridge Smith PD, Scurr JH: Objective assessment of high ligation without stripping the long saphenous vein. Br J Surg 78: 1139-1142, 1991.[ISI][Medline] [Order article via Infotrieve]
  • Friedell ML, Samson RH, Cohen MJ, et al: High ligation of the greater saphenous vein for treatment of lower extremity varicosities: The fate of the vein and therapeutic results. Ann Vasc Surg 6: 5-8, 1992.[CrossRef][Medline] [Order article via Infotrieve]
  • Campanello M, Hammarsten J, Forsberg C, et al: Standard stripping versus long saphenous vein-saving surgery for primary varicose veins: A prospective, randomized study with the patients as their own controls. Phlebology 11: 45-49, 1996.
  • Recek C: Spätergebnisse nach Krossektomie und Sklerotherapie. Phlebologie 29: 23-26, 2000.

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[Abstract] [Full Text] [PDF]

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