Fig. 8.

Hemodynamic paradox. Elimination of saphenous reflux in the groin restored physiological hemodynamic conditions (I, II), but at the same time it generated prerequisite for the comeback of previous pathological situation with recurrent reflux (III). Strain-gauge plethysmography evaluating refill time t-90, t-50, and refill volume in patients with very severe chronic venous insufficiency displayed the gravest form of hemodynamic disturbance before operation (B); reestablishment of physiological hemodynamic conditions was achieved in the presence of large incompetent calf perforators 1 week after pure crossectomy without any additional measure (A). However, abolition of saphenous reflux generated pressure difference between the femoral vein and the saphenous remnant, which set off biophysical and biochemical events evoking recurrent reflux. For more details, see text.