[Two false myths of the 20th century vascular surgery]

Two myths or dogmas have influenced the therapeutic proceeding of phlebological surgeons in the second half of the 20th century, and both did not stopped to wield their influence up to the present time. The first one is the Cockett's theory of the incompetent calf perforators (blow-out syndrome), the second one is the assertion that femoral vein incompetence invariably causes the most serious stage of chronic venous insufficiency. The incorrectness of the theory of incompetent calf perforators was documented by venous pressure measurements, including direct pressure and electromagnetic flow measurements in the incompetent calf perforators themselves, as well as by plethysmographic results after surgical procedures eliminating the saphenous reflux. The pressure measurements showed that incompetent calf perforators did not cause ambulatory venous hypertension in the superficial veins of the gaiter area; directly the opposite happened: the high hydrostatic pressure measured in the quiet standing position in the incompetent calf perforator decreased profoundly during calf pump activity, as soon as the saphenous reflux was interrupted by digital compression. As to the femoral vein incompetence, no direct evidence has so far been presented which would confirm its hemodynamic significance. On the contrary, plethysmographic findings in patients displaying both saphenous and femoral vein incompetence showed that saphenous reflux was the factor which was responsible for the hemodynamic derangement, whereas femoral vein incompetence was hemodynamically irrelevant.