ABSTRACT
Deep venous reconstruction, a development of the past 50 years, is a consequence of the evolving appreciation of the pathological processes that affect the veins in the lower limbs. Early contributions of Homans,1 Linton,2 Cockett3 and others were instrumental in focusing attention on the pathological sequelae of thrombophlebitis. Through the imaginative use of venography in the 1940s, Gunnar Bauer4 in Sweden was able to discern the pathological findings in both primary and secondary deep vein reflux and to separate reflux from obstructive states in the deep veins. He was the first to describe primary deep valve incompetence, which he termed ‘idiopathic’ incompetence. Physiological studies of venous pressure and of venous volume were widely reported using various techniques, but the most significant development has been the non-invasive use of imaging by ultrasound which has resulted in the sophisticated duplex scan technology available today. The ability to perform a non-invasive study of the entire deep venous system in the lower extremity safely, economically, and painlessly has made it possible to observe the veins in situ without disturbing normal flow. The effects produced by venous hemodynamics can now be observed at will in the veins of the erect human in health and disease. This is necessary because there is no satisfactory animal model that can be used to substitute for the human to study venous physiology and pathology.
