Comparative Studies of the Blood of Normal and Varicose Veins

Abstract

description of the centrifugal blood flow in varicosities of the saphenous veins of patients examined in the erect position and Magnus' (2) discovery of the so-called &dquo;private circulation&dquo; seem to have furnished a reasonable explanation of the pathogenesis of varicosities and their sequelae. Both authors assumed that the poor quality of the insufficiently regenerated blood in the varicosities would ultimately lead to tissue asphyxiation. According to Magnus the blood in varicosities contains an increased amount of carbon dioxide, whereas Klapp (3) has found an elevated quantity of nonprotein nitrogen. However, the blood chemistry studies of Klapp (4, 5) and his coworkers are not too reliable. The figures reported vary too much when blood taken from different veins of the body was analyzed, and an increase of the nonprotein nitrogen was frequently found even in specimens taken from veins which were macroscopically intact. These apparent discrepancies induced the authors to introduce a new technical term: &dquo;functional&dquo; varicosities. Moreover, none of Hlapp's collaborators was ever able to find an increased C02 content in the blood of varicose veins.Additional investigations of the blood flow in varicose veins cast even more doubt upon the correctness of the term &dquo;private circulation.&dquo; Haxthausen (6), by simply injecting dye into the veins, could prove that the circulation of blood in varicose veins was equally complete and that the blood moved at the same speed as did the blood in the intact veins. Fischer (7) could demonstrate that radiopaque dyes injected into the saphenous veins would first follow the gravitation and descend somewhat, but shortly afterward would vanish completely. This could mean only that the dyes were taken up and carried away with the blood stream. Now, the so-called &dquo;private circulation&dquo; is said to consist of one slow and one very fast leg. The former is composed of the varicosed part and the latter one of the popliteal vein itself. The circulation in the popliteal vein is about 10 times as fast as that in the varicose veins. Therefore the blood of the varicosity is being diluted 10 times during the first circuit of the blood, 100 times during the second and 1,000 times during the third. Obviously there is no stagnation of the blood flow. The most one can say is that blood coming out of the varicose veins makes a detour from an area of high pressure (16 cm Hg) to another of low pressure in the popliteal vein (1 cm Hg).But that is not all. Painstaking reinvestigations (8,9) have also disproved the theory of increased metabolic remnants in the blood of varicose veins. However, the theory still retained its place, despite all the results to the contrary brought to light by newer research. Its influence can be felt in almost every paper dealing with the varicosity problem. It goes even so far that a new remedy (Cir-