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Pathogenesis of Chronic Venous Insufficiency

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Chronic Venous Insufficiency

Abstract

Until pharmacologic methods are available to block the fundamental processes which lead to venous ulceration, a surgical approach will continue to be necessary. Chronic venous insufficiency (CVI) occurs when the fundamental mechanisms of venous blood transport are deranged. Abnormalities can occur in either the superficial venous system, the deep venous system, the perforating veins, or combinations of these. Furthermore, it is important to recognize that venous ulceration may be caused by simple varicose veins and this occurs in some 20 to 50% of venous leg ulcers. Conversely, the venous abnormality may be in the deep venous system with reflux occurring only there and not in superficial veins. In a percentage as small as 4 or 5%, the valve dysfunction may occur in the perforating veins alone.

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References

  1. Douglas WS, Simpson NB. Guidelines for the management of chronic venous leg ulceration. Report of a multidisciplinary workshop. Br J Dermatol 1995; 132:446–52

    Article  Google Scholar 

  2. Blalock A. Oxygen content of blood in patients with varicose veins. Arch Surg 1929; 19:898–905

    Article  CAS  Google Scholar 

  3. Blumhoff RL, Johnson G. saphenous vein Рр02 in patients with varicose veins. J Surg Res 1977; 23:35–6

    Article  Google Scholar 

  4. hami SK, Chittenden SJ, Scurr JH, Coleridge Smith PD. Skin blood flow in chronic venous insufficiency. Phlebology 1993; 8:72–6

    Google Scholar 

  5. Shari SK, Cheatle TR, Chittenden SJ, Scurr JH, Coleridge Smith PD. Hyperaemic response in the skin microcirculation of patients with chronic venous insufficiency. Br J Surg 1993; 80:433–5

    Article  Google Scholar 

  6. Pratt GH. Arterial varices: a syndrome. Am J Surg 1949; 77:456–60

    Article  PubMed  CAS  Google Scholar 

  7. Brewer AC. Arteriovenous shunts. Br Med J 1950; ii:270

    Google Scholar 

  8. Lindmayr W, Lofferer 0, Mostbeck A, Partsch H. Arteriovenous shunts in primary varicosis: a critical essay. Vasc Surg 1972; 6:9–14

    Article  Google Scholar 

  9. Browse NL, Burnand KG. The cause of venous ulceration. Lancet 1982; ii:243–5

    Google Scholar 

  10. Arming JT. Leg ulcers: their cause and treatment. Churchill Livingstone, London, 1954

    Google Scholar 

  11. Debure C. La maladie postphlebitique des membres inferieurs: quoi de neuf en 1993? Actualites D’Angiologie 1993; 18;147–50

    Google Scholar 

  12. Owens JC. Management of postphlebitic syndrome. Vasc Diagn Ther 1981; 3:34–40

    Google Scholar 

  13. Mudge M, Leinster SJ, Hughes LE. A prospective 10 year study of the post-thrombotic syndrome in a surgical population. Ann Roy Coll Surg Engl 1988; 70:249–52

    CAS  Google Scholar 

  14. Ludbrook J. Post-thrombotic venous obstruction in the lower limb. Editorial. Arch Surg 1973; 106:11–12

    Article  PubMed  CAS  Google Scholar 

  15. Gourdin FW, Smith Jr, J. Etiology of venous ulceration. South Med J 1993; 86:1142–6

    Article  PubMed  CAS  Google Scholar 

  16. Payne SPK, London NJM, Newland CJ et al. Ambulatory venous pressure: correlation with skin condition and role in identifying surgically correctable disease. Eur J Vasc Endovasc Surg 1996; 11:195–200

    Article  PubMed  CAS  Google Scholar 

  17. van Bemmelen PS. Invasive methods - radiology and venous pressure. In: van Bemmelen P (ed.) Quantitative measurement of venous incompetence. R.G. Landes Co, Austin, 1992:29

    Google Scholar 

  18. Taheri SA, Pendergast D, Lazar E et al. Continuous ambulatory venous pressure for diagnosis of venous insufficiency. Am J Surg 1985; 150:203–6

    Article  PubMed  CAS  Google Scholar 

  19. Raju S, Fredericks R. Hemodynamic basis of stasis ulcration: a hypothesis. J Vasc Surg 1991; 13:491–5

    Article  PubMed  CAS  Google Scholar 

  20. Negus D. Perforating vein interruption in the postphlebitic syndrome. In: Bergan JJ, Tao JST (eds) Surgery of the veins. Grune & Stratton, Orlando, 1985: 196

    Google Scholar 

  21. Coleridge Smith PD, Thomas P, Scurr JH, Dormandy JA. Causes of venous ulceration: a new hypothesis. Br Med J 1988; 296:1726–7

    Article  CAS  Google Scholar 

  22. Adams DO, Hamilton TA. The cell biology of macrophage activation. Ann Rev Immunol 1984; 2:283–318

    Article  CAS  Google Scholar 

  23. Ono T, Bergan JJ, Schmid-Schönbein GW, Takase S. Monocyte infiltration into venous valves. J Vasc Surg 1998; 27:158–66

    Article  PubMed  CAS  Google Scholar 

  24. Pober JS. Cytokine-mediated activation of vascular endothelium. Am J Pathol 1988; 133:426–33

    PubMed  CAS  Google Scholar 

  25. Schleef RR, Bevilaqua MP, Sawdey M, Gimbrone MA, Loskutoff DJ. Cytokine activation of vascular endothelium: Effects on tissue-type plasminogen activator and type 1 plasminogen activator inhibitor. J Biol Soc 1988; 163:5797–803

    Google Scholar 

  26. Coleridge Smith PD. Conclusions and future directions. In: Coleridge-Smith PD (ed.) Microcirculation in venous disease. R.G. Landes Co., Austin, 1994: 192–4

    Google Scholar 

  27. Coleridge Smith PD. Etiology and pathophysiology of chronic venous insufficiency. http://www.uсl.aс.uk/-rehk999/pdcs.htm

    Google Scholar 

  28. Wilkinson LS, Bunker C, Edwards JCW, Scurr JH, Coleridge Smith DP. Leukocytes: Their role in the etiopathogenesis of skin damage in venous disease. J Vasc Surg 1993; 17:669–75

    Article  PubMed  CAS  Google Scholar 

  29. Coleridge Smith PD. Venous ulcer. Br J Surg 1994; 81:1404–5

    Article  Google Scholar 

  30. Leu AJ, Leu H-J, Franzeck UK, Bollinger A. Microvascular changes in chronic venous insufficiency: a review. Cardiovasc Surg 1995; 3:237–45

    Article  PubMed  CAS  Google Scholar 

  31. Bradbury AW, Murie JA, Ruckley CV. Role of the leucocyte in the pathogenesis of vascular disease. Br J Surg 1993; 80:1503–12.

    Article  PubMed  CAS  Google Scholar 

  32. Christopoulos D, Nicolaides AN, Cook A, Irvine A, Galloway JMD, Wilkinson A. Pathogenesis of venous ulceration in relation to the calf muscle pump function. Surgery 1989; 106:829–35

    PubMed  CAS  Google Scholar 

  33. Myers KA, Ziegenbein W, Zeng GE, Matthews PG. Duplex ultrasonography scanning for chronic venous disease: patterns of venous reflux. J Vasc Surg 1995; 21:605–12

    Article  PubMed  CAS  Google Scholar 

  34. Shari SK, Sarin S, Cheatle TR, Scurr JH, Coleridge Smith PD. Venous ulcers and the superficial venous system. J Vasc Surg 1993; 17:487–90

    Google Scholar 

  35. Sarin S, Scurr JH, Coleridge Smith PD. Medial calf perforators in venous disease: the significance of outward flow. J Vasc Surg 1992; 16:40–6

    Article  PubMed  CAS  Google Scholar 

  36. McMullin GM, Scott HJ, Coleridge Smith PD, Scurr JH. A comparison of photoplethysmography, Doppler, and duplex in the assessment of venous insufficiency. Phlebology 1989; 4:75–82

    Google Scholar 

  37. Darke SG, Penfold C. Venous ulceration and saphenous ligation. Eur J Vasc Surg 1992; 6:4–9

    Article  PubMed  CAS  Google Scholar 

  38. Hanrahan LM, Araki СТ, Rodriguez AA et al. Distribution of valvular incompetence in patients with venous stasis ulceration. J Vasc Surg 1991; 13:805–12

    Article  PubMed  CAS  Google Scholar 

  39. Shami SK, Sarin S, Cheatle TR, Scurr JH, Coleridge Smith PD. Venous ulcers and the superficial venous system. J Vasc Surg 1993; 17:487–90

    Article  PubMed  CAS  Google Scholar 

  40. Walsh JC, Bergan, Beeman S, Comer TP. Femoral venous reflux abolished by greater saphenous vein stripping. Ann Vasc Surg 1994; 8:566–70

    Article  PubMed  CAS  Google Scholar 

  41. Goren G. Letter to the Editor - Regarding venous ulcers and the superficial venous system. J Vasc Surg 1996; 18:716–19

    Google Scholar 

  42. Sales CM, Bilof ML, Petrillo KA, Luka NL. Correction of lower extremity deep venous incompetence by ablation of superficial venous reflux. Ann Vase Surg 1996; 10:186–90

    Article  CAS  Google Scholar 

  43. Padberg Jr FT, Pappas PJ, Araki СТ, Back TL, Hobson II RW. Hemodynamic and clinical improvement after superficial vein ablation in primary combined venous insufficiency with ulceration. J Vase Surg 1996; 24:711–18

    Article  Google Scholar 

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Authors
  1. Jeffrey L. Ballard
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  2. John J. Bergan
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  3. Steven Sparks
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Editor information

Editors and Affiliations

  1. Division of Vascular Surgery, Loma Linda University Medical Center, 11175 Campus St, RM#21123, Loma Linda, California, CA, 92354, USA

    Jeffrey L. Ballard MD, FACS

  2. North Coast Surgeons, 9850 Genessee Avenue, Suite 560, La Jolla, California, CA, 92037, USA

    John J. Bergan MD FACS

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© 2000 Springer-Verlag London

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Ballard, J.L., Bergan, J.J., Sparks, S. (2000). Pathogenesis of Chronic Venous Insufficiency. In: Ballard, J.L., Bergan, J.J. (eds) Chronic Venous Insufficiency. Springer, London. https://doi.org/10.1007/978-1-4471-0473-5_3

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  • DOI: https://doi.org/10.1007/978-1-4471-0473-5_3

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-1149-8

  • Online ISBN: 978-1-4471-0473-5

  • eBook Packages: Springer Book Archive

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