[Evaluation of the hemodynamic significance of femoral vein insufficiency].

Deep vein incompetence is generally regarded as the main cause of severe chronic venous insufficiency, without specifying which deep vein segments are really meant. Opinions concerning hemodynamic significance of femoral vein incompetence differ considerably. Femoral vein incompetence can be part of a postthrombotic syndrome, it can occur as a primary incompetence described by Kistner or as a secondary incompetence due to vein dilatation. Therapeutic possibilities and outcome of valvuloplasty and valve transplantation described in the literature are presented. The results of valve transplantation into the popliteal vein in postthrombotic patients were disappointing. In primary varicose veins the saphenous incompetence is often accompanied by femoral vein reflux which mostly disappears after removal of incompetent saphenous vein; the possible mechanism causing this phenomenon is discussed. In cases with combined saphenous and femoral vein reflux the most important factor causing venous derangement is the saphenous reflux, not the femoral vein incompetence; therefore, the first therapeutic step in such cases must be the abolition of saphenous reflux. The question whether femoral vein incompetence deteriorates the natural course of primary varicose veins can't so far be answered conclusively, but the first reports concerning this issue show that it could be answered yes.