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 Venous System of the Lower Extremities: Physiology and Pathophysiology

1. Anatomy

  • The superficial system of veins.
  • The deep system of veins.
  • The perforating veins.
  • Structure of venous wall.

2. Physiology

  • Venous hemodynamics.
  • Venous pressures.
  • The calf muscle pump.
  • The thoracoabdominal muscle pump.
  • Venous tone.
  • Venous endothelium.

3. Clinical tests of physiologic function of the venous system

  • Ambulatory venous pressure.
  • Arm-foot pressure differential.
  • Ascending and descending venography.
  • Air-plethysmography.
  • Photoplethysmography.
  • Duplex ultrasound.

4. Pathophysiology

  • Varicose veins (epidemiology, pathology, pathophysiology).
  • Chronis venous insufficiency (epidemiology, pathology, pathogenesis).


Nicolaides AN. Investigation of chronic venous insufficiency: A consensus statement (France, March 5-9, 1997). Circulation 2000;102:E126-63.

This consensus document provides an up-to-date account of the various methods available for the investigation of chronic venous insufficiency of the lower limbs, with an outline of their history, usefulness, limitations and indications of which patients should be subjected to the tests and when and of what clinical decisions can be made.

Somjen GM. Anatomy of the superficial venous system. Dermatol Surg 1995; 21:35 -45.

This paper is aimed at providing basic anatomic information of the lower extremity venous system. It also highlights the new research areas and the changing concepts on the pathophysiology of varicose veins.

Marston WA . PPG, APG, duplex: which noninvasive tests are most appropriate for the management of patients with chronic venous insufficiency? Semin Vasc Surg 2002;15:13-20.

Numerous noninvasive tests including venous duplex ultrasound, photoplethysmography and air plethysmography have been described for assistance in the diagnosis and treatment of patients with chronic venous insufficiency. These tests are reviewed including the typical information obtained, the usefulness of this information, and the relevance for clinical management of patients with CVI. Based on the clinical class, recommendations for a noninvasive testing protocol are outlined.

Gschwandtner ME, Ehringer H. Microcirculation in chronic venous insufficiency. Vasc Med 2001;6:169-179.

In this review, the anatomy and physiology of the venous system and its pathophysiology are described. Theories regarding the possible causes of disturbances in venous microangiopathy as well as the recently discovered pattern of perfusion in microcirculation within and around venous ulcers are also discussed.

Schmid-Schonbein GW, Takase S, Bergan JJ. New advances in the understanding of the pathophysiology of chronic venous insufficiency. Angiology 2001;52 Suppl 1:S27-34.

Chronic venous insufficiency is inseparably linked to elevated venous pressure and is accompanied by vascular, dermal, and subcutaneous tissue damage and restructuring. Among several possible mechanisms (hypoxia, humoral stimulation), a shift in fluid shear stress from normal physiological levels and endothelial distension under the influence of elevated venous pressure may serve as trigger mechanisms for inflammation. The key role of inflammation in chronic venous insufficiency including its trigger mechanisms and consequences is summarized in this review.

Posted June 2010