Chronic Venous Insufficiency

K. BALzER

10.1.1 Introduction

• Nearly every second adult in Europe suffers from venous disorders.

• In only 15% are they considered to be venous diseases threatening the patient.

• The spectrum ranges from spider telangiectasia to chronic states and acute, potentially lethal, pulmonary embolism - generally described as chronic venous insufficiency (CVI).

• In vascular surgery, varicosities of the greater saphe-nous vein in particular are important.

• In principle, every varicose disorder leading to symptoms such as oedema and lower leg ulcer should be treated surgically [1,4,16, 21].

10.1.2 Functional Anatomy and Physiology of the Venous System

10.1.2.1 Superficial Veins

• The greater and lesser saphenous veins belong to the superficial venous system [16,18, 22, 25].

• They drain the area between the skin and muscle fascia, carrying blood to the deep venous system.

• Before the greater saphenous vein enters the deep femoral vein numerous small tributaries join the system.

• The saphenofemoral junction plays an essential part in the function of the venous system during deep venous thrombosis and in treatment of varicosities.

10.1.2.2 Deep Veins

• Because the deep veins are located close to the arteries, they are called popliteal and femoral veins.

• Duplication of these veins exists in most patients.

• They drain 90% of the blood in the legs [4, 5,16, 25].

10.1.2.3 Perforating Veins

• In the upper and lower leg perforating veins (venae perforantes or communicantes) link the superficial and deep venous systems in a step-like manner.

• Important perforating veins are the Cockett's (medial ankle), Boyd's (proximal medial calf) and Dodd's group (medial upper leg).

• Upright body posture demands transportation of blood back to the heart against the force of gravity. To a certain degree, this is accomplished by the suction effect of the heart and the thoracoabdominal pump function of breathing. The tone of the venous system, arteriovenous coupling (transfer of the arterial pulse to a neighbouring vein) and relative venous blood volume (total body blood volume is usually split 80% venous and 20% arterial, with different proportions during exertion) also play an important role. However, the most important mechanism is the calf muscle pump which, in combination with competent venous valves, guarantees blood flow to the heart by muscle contraction.

• Physiologically, valves of the deep, superficial and perforating veins open unidirectionally, preventing flow reversal in the venous system and thus protecting the legs from the effects of continuous hydrostatic pressure [10,14,16,18].

10.1.3 Chronic Venous Insufficiency

10.1.3.1 Definition

• Chronic venous insufficiency (CVI) describes the state of continuous venous hypertension of the lower limb

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