Pathophysiology of varicose veins

Background: Varicose veins, a common problem with effects on quality of life, account for a significant cost burden on the health care system. Despite their prevalence, the pathophysiologic mechanism of varicose veins remains incompletely understood. The fundamental issue is whether venous hypertension and valvular incompetence precede and influence the development of vein wall changes or whether the reverse is true. Methods: We have reviewed the English-language literature to provide the most current understanding of the hemodynamic and cellular and molecular processes that underlie the development of varicose veins. Results: Data at this time remain inconclusive, with compelling arguments to be made for both sides. It is clear that valvular incompetence and hemodynamic factors play a significant role, despite heterogeneity in study findings and lack of clear data for a specific pattern of valvular incompetence as an inciting factor. Numerous factors influence the development of varices on the cellular level, including hypoxia, dysregulated apoptosis, and alterations in the extracellular matrix. Conclusions: Based on currently available evidence, varicose veins are a complex disease with multifactorial pathogenesis: it is as yet not possible to state conclusively what inciting factor is responsible for the development of varicose veins, and their development may result from imbalance of any number of several factors.