Myths, mystique, and misconceptions of venous disease

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Myths, mystique, and misconceptions of venous disease Anthony J. Comerota, MD Journal of Vascular Surgery Volume 34, Issue 5, Pages 765-773 (November 2001) DOI: 10.1067/mva.2001.116099 Copyright © 2001 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions

Fig. 1 Obstruction of the vein lumen, which contributes to chronic venous insufficiency, should be viewed conceptually as any compromise of the vein lumen between 1% and 99%. Complete obliteration of the vein lumen is occlusion. Journal of Vascular Surgery 2001 34, 765-773DOI: (10.1067/mva.2001.116099) Copyright © 2001 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions

Fig. 2 Cross-section photograph of the proximal femoral vein of a post-thrombotic man with venous ulceration who had a classic Linton procedure performed. The femoral vein below the profunda femoris vein was ligated and divided. Note multiple-channel recanalization of vein lumen; however, a large percentage of the vein lumen is “obstructed.” B, An ascending phlebogram of the patient's leg preoperatively shows the recanalized femoral vein; however, the official interpretation indicated that there was “chronic disease but no evidence of obstruction.” Journal of Vascular Surgery 2001 34, 765-773DOI: (10.1067/mva.2001.116099) Copyright © 2001 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions

Fig. 3 Scanning electron micrograph of the jugular vein of a dog that had 6 hours of general anesthesia but no operation. Jugular vein dilated minimally (<10% of baseline diameter) during the experiment. A, High-power magnification showing a smooth, intact endothelial monolayer. B, Lower-power magnification showing normal endothelium and a normal valve cusp (–N ). Journal of Vascular Surgery 2001 34, 765-773DOI: (10.1067/mva.2001.116099) Copyright © 2001 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions

Fig. 4 Scanning electron micrograph of the jugular vein of a dog that had a total hip replacement (OP). The jugular vein dilated >28% of baseline diameter during the experiment. A, Low-power magnification showing vein lumen and valve leaflet; note damage to vein wall in valve cusp. B, High-power magnification showing all of the elements of thrombus on the injured surface. C, Intermediate magnification shows tearing injury of endothelium within the valve cusp. Journal of Vascular Surgery 2001 34, 765-773DOI: (10.1067/mva.2001.116099) Copyright © 2001 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions