Pathogenesis and hemodynamics of varicose veins and chronic venous insufficiency of the lower limb

The term chronic venous insufficiency (CVI) is used rather broadly by many physicians in reference to the entire spectrum of nonacute venous disorders. The development and revision of the CEAP classification and the Venous Clinical Severity Scores (VCSS) provided a methodology for describing specific venous disorders and clarified that CVI implies a functional abnormality of the venous system (see Chapter 9). Both CEAP and VCSS are recommended for use by clinical practice guidelines.1–3 CVI should be reserved for the description of more advanced disease, beginning with venous edema (C3), but more commonly in conditions with skin changes (C4) or ulceration (C5–C6). In this chapter, we will discuss the pathophysiology and hemodynamics impairing normal function of the superficial and deep venous system. A distinction will be made between the roles of obstruction and valvular incompetence.