Recek C
Vienna, Austria.
Angiology. 2006 Oct-Nov;57(5):556-63. doi: 10.1177/0003319706293117.
Contradictory reports on the significance of several hemodynamic phenomena, such as femoral vein incompetence and incompetent calf perforators, impede orientation in venous hemodynamics. Venous pressure difference arising between the popliteal and the posterior tibial vein during the activity of the calf muscle venous pump was reported for the first time about 50 years ago, but regrettably, this important discovery continues to be unrespected. The venous pressure difference has since been termed ambulatory pressure gradient and seems to be the key factor triggering the venous reflux in the lower limb as well as the process leading to varicose vein recurrence. On the other hand, simultaneous recordings of the mean venous pressure in the posterior tibial and long saphenous veins demonstrated that the pressure curves have been identical at rest, during ambulation, and in the recovery period, a finding typical of conjoined vessels. Bidirectional flow within calf perforators taking place both in healthy subjects and in patients with varicose veins enables a quick equilibration of pressure changes between deep and superficial veins of the lower leg. Reflux disturbing the venous hemodynamics is in various degrees dependent on the quantity of retrograde flow; abolition of reflux restores normal venous hemodynamics. Reflux in superficial veins, if large enough, may cause the most severe form of chronic venous insufficiency. Femoral vein incompetence and incompetent calf perforators per se do not produce ambulatory venous hypertension and do not cause hemodynamic disturbance. This study discusses the controversial issues, tries to define and appraise the principal hemodynamic phenomena (ambulatory venous hypertension, ambulatory pressure gradient, venous reflux, superficial and deep vein incompetence, incompetent perforators), mentions a possible relation between deep vein incompetence and varicose veins, and attempts to present, based on proved facts, a comprehensive picture of the venous hemodynamics in the lower extremity.
关于几种血流动力学现象的重要性，如股静脉功能不全和小腿穿支静脉功能不全，存在相互矛盾的报道，这妨碍了对静脉血流动力学的理解。大约50年前首次报道了在小腿肌肉静脉泵活动期间腘静脉和胫后静脉之间出现的静脉压力差，但遗憾的是，这一重要发现仍然未得到重视。此后，该静脉压力差被称为动态压力梯度，似乎是引发下肢静脉反流以及导致静脉曲张复发过程的关键因素。另一方面，对胫后静脉和大隐静脉平均静脉压力的同步记录表明，在静息、行走和恢复期间，压力曲线是相同的，这是联合血管的典型表现。在健康受试者和静脉曲张患者中，小腿穿支静脉内的双向血流能够使小腿深静脉和浅静脉之间的压力变化快速平衡。干扰静脉血流动力学的反流在不同程度上取决于逆流的量；消除反流可恢复正常的静脉血流动力学。浅静脉反流如果足够大，可能会导致最严重形式的慢性静脉功能不全。股静脉功能不全和小腿穿支静脉功能不全本身不会产生动态静脉高压，也不会引起血流动力学紊乱。本研究讨论了这些有争议的问题，试图定义和评估主要的血流动力学现象（动态静脉高压、动态压力梯度、静脉反流、浅静脉和深静脉功能不全、穿支静脉功能不全），提及深静脉功能不全与静脉曲张之间可能的关系，并试图基于已证实的事实，呈现下肢静脉血流动力学的全貌。
