atrophy), which occurs almost exclusively as a conse-
Diagram of blood return:
quence of CVI. Characteristic signs of this skin alteration
1) In the physiological situation.
2) In primary varicosis: valve clo-
are white, atrophic focal lesions ranging in size from a
sure is no longer possible due to
coin to the palm of the hand, and are found mainly in the
the vascular dilatation, the direc-
ankle region or around scars of healed ulcerations.
tion of blood flow reverses.
3) In secondary varicosis: scarring
and loss of elasticity of the super-
Grade III manifests as a florid or healed venous leg ulcer.
ficial veins after deep leg vein
Its site of predilection is the perimalleolar region
thrombosis leads to valve incom-
(Bisgaard region), but it can also occur elsewhere on the
petence, the blood flows through
1 2 3
lower leg. Ulcerations can also spread to cover the entire
the perforating veins back into
the suprafascial system.
lower leg in a circular pattern resembling a gaiter.
disposition is promoted by factors such as hormonal influ-
Pathophysiology of CVI ences during pregnancy, lack of exercise or inflammatory
Chronic venous insufficiency can either be the result of processes. If lumen enlargement and valvular insufficien-
primary varicosis or a consequence of a postthrombotic cy occur in the large superficial leg veins (great and small
syndrome; the anatomical localization of the flow obsta- saphenous vein), the disease is known as saphenous vari-
cle is the factor that determines the clinical prognosis. cosity. Lateral branch varicosis is present when the lateral
branches of the saphenous vein are affected by these
Suprafascial venous insufficiency / primary varicosis changes, while varicose extensions of the communicating
The most important disease of the superficial leg vein sys- veins are known as reticular varicosis.
tem is primary varicosis or varicose veins. Varicose veins
are abnormally and irregularly swollen veins with a typi- Since only about 10 % of the venous blood is returned to
cally tortuous course visible below the skin. They can be the heart through the superficial veins, a functional disor-
caused by valve agenesia (congenital absence of venous der of individual venous segments can usually be com-
valves), but more often it is hereditary or age-related loss pensated without much difficulty by blood being diverted
of elasticity of the venous walls that leads to vascular to other venous plexuses or by the intact deep communi-
dilatation and valve incompetence. This congenital pre- cating veins assuming the transport functions. The clinical
situation undergoes a serious change, however, when
lumen enlargement and valve incompetence also begin to
Varicose veins are not merely a
affect the perforating and subfascial veins. The direction
“cosmetic problem”. Vascular
of venous flow is then reversed, leading to disorders of
dilatation and valvular insuffi-
ciency can progress through the
physiological return and retrograde flow conditions.
perforating veins to affect the
deep veins, resulting in chronic
venous insufficiency and ulcera-
tion.
Causes [12.13]
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