Abstract
In the patient with chronic venous disease, venous hypertension occur which result in inability of calf pumps and conduits in the venous system to maintain a normal pressure and normal flow towards the heart. Venous hypertension is caused by venous reflux, obstruction, a combination of reflux and obstruction or arterio-venous fistula. Compensation for obstruction are the development of collateral vein circulation and lymphatic drainage. The clinical symptoms and signs are a result of the venous hypertension and the lack of compensation. Inability to quantitate these factors in individual patients contributes to an incomplete understanding of the pathophysiology, leading to controversies and significant challenges in managing chronic venous disease.