ABSTRACT
Chronic venous disease is a complex disorder affecting the macro-as well as the micro-
circulation. Venous function is dependant on many factors, not only reflux and obstruction,
but also calf muscle pump function (ankle/knee joint status and muscle mass), venous
volume, vein wall compliance and geometry. It is undoubtedly difficult to separate the
contribution of these different factors to the condition of the patient by testing. It is important
that the utilized test is identified as whether it measures anatomic or functional aspects of
venous disorders. Invasive tests to assess venous function and morphology have been
largely replaced by noninvasive tests, at least for the initial evaluation. Despite the
importance of assessing sensitivity, specificity and accuracy of individual tests, these
calculations are hindered by the lack of acceptable “gold standards.” For decades tests such
as invasive ambulatory foot venous pressure and descending venography were considered
the ultimate reference tests, but presently their role as “gold standards” is in doubt.
Nevertheless, invasive tests are often necessary to identify anatomic sites of disease for final
invasive treatment and can, in some situations, not be replaced by noninvasive evaluation.