The Importance of Ambulatory Venous Hypertension Should Be Revised

Abstract

Inadequate decrease of venous pressure in patients with varicose vein while walking and exercising is called ambulatory venous hypertension (AVH). It has been considered as the main cause of chronic venous insufficiency. However, venous pressure in lower limbs while standing (95 mmHg) and sitting (70 mmHg) remains higher most of the day compared to AVH (healthy persons 26 mmHg, patients with varicose veins 41 mmHg). Published values of venous pressure in lower limbs in healthy persons and in patients with varicose veins in lower limbs, obtained while lying, standing, standing with small movements, sitting and walking, and the reported times, were used to calculate the mean venous pressure for 24 hours. Photoplethysmographic testing was used for indirect evaluation of venous haemodynamics in intensive and moderate exercise in sitting subjects. Patients with varicose veins restrict standing times; taking into account this fact, mean venous pressure for 24 hours reached 48.71 mmHg in healthy persons and 49.56 mmHg in patients with varicose vein (CEAP C2 stage). The difference is very small and cannot be the fundamental pathophysiological mechanism of development of venous insufficiency. Conclusion: 24-hour venous pressure in legs in healthy persons and in persons with varicose veins in lower limbs shows only a very small difference. The importance of AVH, particularly in initial stages of the disease, should be revised.