Background Knowledge Of Nonthrombotic Reflux Deep Vein Disease

Except for the publications of Gunnar Bauer in the 1940s,4 clinically important deep vein reflux disease had been attributed to post-thrombotic disease. Bauer was a brilliant investigator-surgeon who worked in a small hospital in Mariestad, Sweden, in the mid-1900s. He experimented with venogra-phy in patients suspected of having venous disease and devised a method of performing descending venography, described in 1948. These venograms were performed with a needle in the CFV and with the patient in the 45-degree erect position. Static films were obtained to document findings. Bauer was the first to report nonthrombotic cases with highgrade axial reflux in the deep veins, and to associate these cases with advanced stages of clinical venous insufficiency. He treated these cases with popliteal vein ligation and reported early clinical success, but later follow-up of some of these cases by his peers in Sweden discredited the long-term value of popliteal vein ligation.

Bauer's descending venography resulted in activity in other sites around the world, as reflected by reports that appeared in the early 1950s.5,6 Confusion arose from these reports when it was found that deep reflux was associated with symptoms in some cases, whereas other cases were asymptomatic. As a result of this confusion with descending venography and the report that popliteal vein ligation was a questionable procedure, this entity, which had been titled idiopathic nonthrombotic reflux by Bauer, apparently lost credibility as an important cause of venous insufficiency in the 1950s and lay dormant until venous valve repair surfaced in 1975.

The description of the reflux entity that Bauer termed idiopathic nonthrombotic venous insufficiency4 is identical to the present-day primary venous insufficiency. This entity is fundamentally different than post-thrombotic disease since there is no element of gross inflammation or scarring of the vein or valve, or intraluminal obstruction with wall thickening as found in the post-thrombotic cases.

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