The role of radial reflux in the genesis of varicose veins

The first section of this paper reviews the clinical, histochemical and histological features of the varicosity in the early stage of human varicose veins. The second section demonstrates that many of those features have been duplicated in acute experiments where noradrenaline perfused the vasa venarum of an isolated in situ canine vein segment, the drug having reached the vasa by reflux from the lumen of the segment (radial reflux). It also explains how perfusion of the vasa for an extended period would duplicate other distinctive features of the early-stage human varicosity, such as its permanence, the hypoxia of its tissues and the hypertrophy of the smooth muscle in its wall. The findings further support the hypothesis that varicose veins arise from chronic perfusion of the vasa venarum of a normal vein by circulating noradrenaline contained in pathologically high volumes of radial venous reflux. The main cause of the high volume of reflux seems to be turbulent luminal flow in the case of secondary varicose veins and a real or relative structural deficiency of the fibroelastic of the valve aggers in the case of primary ones.