Abstract：
Substantial advances occurred in phlebological practice in the last two decades. With the use of modern diagnostic equipment, the patients\' venous hemodynamics can be examined in detail in everyday practice. Application of venous segments for arterial bypasses motivated studies on the effect of hemodynamic load on the venous wall. New animal models have been developed to study hemodynamic effects on the venous system. In vivo and in vitro studies revealed cellular phase transitions of venous endothelial, smooth muscle, and fibroblastic cells and changes in connective tissue composition, under hemodynamic load and at different locations of the chronically diseased venous system. This review is an attempt to integrate our knowledge from epidemiology, paleoanthropology and anthropology, clinical and experimental hemodynamic studies, histology, cell physiology, cell pathology, and molecular biology on the complex pathomechanism of this frequent disease. Our conclusion is that the disease is initiated by limited genetic adaptation of mankind not to bipedalism but to bipedalism in the unmoving standing or sitting position. In the course of the disease several pathologic vicious circles emerge, sustained venous hypertension inducing cellular phase transitions, chronic wall inflammation, apoptosis of cells, pathologic dilation, and valvular damage which, in turn, further aggravate the venous hypertension.
摘要：
在过去的二十年中，静脉医学实践取得了重大进展。随着现代诊断设备的使用，患者的静脉血流动力学可以在日常实践中详细检查。静脉段用于动脉旁路的应用激发了血液动力学负荷对静脉壁影响的研究。已经开发了新的动物模型来研究血液动力学对静脉系统的影响。体内和体外研究显示静脉内皮的细胞相变，平滑肌,成纤维细胞和结缔组织组成的变化，在血流动力学负荷下和慢性疾病静脉系统的不同位置。这篇综述试图整合我们的流行病学知识，古人类学和人类学,临床和实验血液动力学研究，组织学,细胞生理学，细胞病理学,和分子生物学对这种常见疾病的复杂病理机制。我们的结论是，这种疾病是由人类对两足动物的有限遗传适应引起的，而不是在不动的站立或坐姿中对两足动物的适应。在疾病的过程中出现了几个病理恶性循环，持续静脉高压诱导细胞相变，慢性壁炎症，细胞凋亡，病理性扩张,和瓣膜损伤，反过来,进一步加重静脉高压。
