Etiology And Pathogenesis Of Varicose Veins

Hippocrates was the first to deal with the pathogenesis and epidemiology of varicose disease when he affirmed that varicose veins were more frequent in Scythians due to the prolonged time spent on the horseback with the legs hanging down. In 1514, Marianus Sanctus noted that varicose veins were more frequent after pregnancy and in longtime standing peoples (". . . standing too much before kings . . ."). In 1545, Ambroise Paré related varicose veins to pregnancy and long travelling and affirmed that they are more frequent in melancholic subjects. Ten years later, Jean Fernel (1554), Professor of Medicine at Paris, stated that varicose veins can develop after an effort or a trauma: ". . . the varix comes also from a blow (?), from a contusion, from an effort . . ." Virchow (1846) was the first to point out the hereditary tendency to varicose veins. Finally, the rare syndrome due to congenital absence of venous valves was first reported by Josephus Luke in 1941.

The first to attribute the onset of varicose veins to valvular incompetence was Hyeronimus Fabricius (1603). The parietal theory first was promulgated by Richard Lower, who in 1670 affirmed that a "relaxatio venarum tono" (wall muscular looseness) is the cause of venous stasis and dilation. Pierre Dionis credited in 1707 an important role to mechanical compression of large trunks in the development of varicose veins, whereas Jean Louis Petit (1774), the eminent French surgeon, reported their possible occurrence during obstruction of proximal veins. According to these two authors, the clinical syndromes due to compression of the left common iliac vein were described by the Canadian McMurrich in 1906, and of the popliteal vein by Rich and Hughes in 1967. Al Sadr described in 1950 the compression of the left renal vein by the aorta and the superior mesenteric artery. Paul Briquet was the first to affirm in 1824 that varicose veins are due to abnormal flow coming from deep veins via the perforators. In 1944, Malan described the occurrence of varicose veins in limbs with abnormal arteriovenous connections. The theory of a subclinical parietal phlogosis inducing venous valve disruption has been proposed only recently by Ono, Bergan, and Schmid-Schonbein.2

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