Abstract
A curious hemodynamic phenomenon emerging as a consequence of the treatment of varicose
veins can offer a reasonable explanation why varicose vein and reflux recurrences
occur tenaciously irrespective of the applied therapeutic procedure. Saphenous reflux
is the most important hemodynamic factor in varicose vein disease: it is responsible
for the hemodynamic disturbance, ambulatory venous hypertension, clinical symptoms,
and chronic venous insufficiency. Abolition of saphenous reflux eliminates the hemodynamic
disturbance and restores physiological hemodynamic and pressure conditions, but at
the same time it unavoidably evokes a pressure difference between the femoral vein
and the incompetent superficial veins in the thigh during calf pump activity. The
pressure difference increases flow and enhances fluid shear stress on the endothelium
in pre-existing minor communicating channels between the femoral vein and the saphenous
system in the thigh, which triggers release of biochemical agents nitride oxide and
vascular endothelial growth factor; the consequence is enlargement (vascular remodeling)
of the communicating channels, and ultimately reflux recurrence.
Hence, the abolition of saphenous reflux creates preconditions for the comeback of
the previous pathological situation. This phenomenon—starting the same trouble while
fixing the problem—has been called hemodynamic paradox; is explains why varicose vein
and reflux recurrence can occur after any mode of therapy.
Keywords
varicose vein recurrence - venous hemodynamics - hemodynamic paradox
