A Guytonian explanation for hemodynamic responses to interventions in superficial venous disease

Abstract

Background: We thank Franceschi et al for their letter entitled “Transmural pressure for conceptualisation of chronic venous insufficiency management” regarding our paper wherein we have repurposed a Guytonian model of systemic venous return to explain the hemodynamic changes that occur in lower limb venous disease.1,2 This model was developed using the non-thrombotic iliac vein lesion (NIVL) as the basis for the hemodynamic response. Franceschi et al have raised queries in their communication that in our model, we have suggested venous stenting, compression therapy and superficial ablation as treatment options for the NIVL. Their concern is that superficial venous ablation will raise transmural pressures within the deep venous compartment, with a worsening of venous compliance, transmission of the higher pressures to the microcirculation leading to trophic changes of venous stasis, as well as recurrences. It is important to state at the outset that we do not advocate superficial venous ablation as a treatment for an NIVL. The NIVL has been used by us purely to develop the model for venous return, not to suggest one form of therapy or another for superficial venous disease. A detailed explanation of the responses to different interventions for superficial venous disease based on our model is now presented to address the issues raised.