Impeded venous drainage: Novel view of chronic venous disease pathophysiology

Venous valve incompetence role as the primary pathology occurring in patients with chronic venous diseases (CVD) has long been exaggerated. Management strategies based on the current pathophysiological concepts are far from perfect. A novel concept is introduced describing the importance of patency of axial venous system with "Pressure gradient model" providing the venous system architecture required for efficient venous drainage. The roles of calf muscle pump, perforators and venous valves according to the novel concept are described. Impeded venous drainage (IVD) plays the key role in the pathophysiology of CVD. Management of CVD should be directed to correction of IVD instead of correction or ablation of valve incompetence. (C) 2009 Elsevier Ltd. All rights reserved.