Primary varices pathogenesis. The appealing unitary model.

Primary varices pathogenesis is still unclear about the trigger event and the disease progression. Throughout time, a lot of hypotheses were created, each with a certain degree of veracity, to explain the aforementioned dilemmas. Present day investigation technologies allowed the undeniable progress in deciphering venous mechanics and biochemistry. Objectifying venous hemodynamic and valvular-parietal changes, their dynamic progression as well, lead to important clarifications in primary varicose disease physiopathogenesis. The importance of establishing a complete, unitary pathogenic model implies the practical possibility of immediately applying the right therapy addressing the pathogenic mechanism of this disease (i.e. correcting the "pressure escape" gateway) correlated with the progression stage (reflux degree) and the type of primary varices (gravitational, non-gravitational, or "suspended" varices). Initially, our study produces a critical evaluation of the classic pathogenic hypotheses and, later on, based on our long time experience in this field, it presents a complete and unitary, evolutive and pathogenic model in primary varices. The proposed model details a pathogenesis and a progression far more nuanced in primary varices, based on solid evidence, having obvious therapeutic implications and predictable results.

The valvular segment of the lower limbs venous system: anatomical, physiological and physiopathological aspects.

The valvular segment is a distinct venous structure, which, from a morphological point of view, is comprised of the following components: the valvular insertion, the valvular gorge entrance orifice, the valvular defile, the valvular gorge exit orifice, the valvular sinus. Endoscopic and echo Doppler examinations are used to identify the normal and the pathological morphology of the valvular segment, and the hemodynamic phenomena occurring at this level. Cusps' integrity and size as well as valvular dynamics are key elements directly involved in shaping the valvular segment in general, and the valvular sinus in particular. The valvular sinus shows an obvious hemodynamic determinism. Valvular segment pathology is the outcome either of a progressively long evolving process initialized by gravitational venous pressure overcharges, or of a rapidly evolving process such as the hemodynamic shock following intense physical efforts. Valvular defunctionalisation implies a different mechanism and a different type of cusp lesion.