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Anatomical, pathological and Doppler-ultrasonographic study has enabled analysis of the various mechanisms participating in normal valve function as well as during insufficiency of the deep and superficial venous systems. This leads to definition of normal morphology and of that of its various pathological changes, analysis of the various mechanisms via study of vein wall and valve behaviour and, finally, to determination that the absolute integrity of the vein wall and its valves is essential if a good hemodynamic result is to be obtained and that these two factors must work together since the inadequacy of one or other would result in valvular insufficiency. The following abnormalities of the ostial valve have been identified: a) loss of insertion into the vein wall of a valve segment, this being the most common; b) valve retraction; c) total destruction of the valve with persistence of fragments. Doppler-ultrasonography has shown that the only visible part of the valve system is the vein wall and the free edge of each valve, enabling determination in a context of valvular insufficiency of the existence of: Vein wall distension. Abnormal valve movements: a) valve prolapse; b) paradoxal movements; c) valve rigidity; d) trans-valve reflux. This same investigation also enabled us to confirm certain differences concerning relative valvular insufficiency, i.e. major vein wall distension accompanied by absence of contact, at the mid-line, with the free edge of each valve. It was possible in the group of patients with insufficiency of the deep venous system to closely evaluate the action of the reflux hypertensive wave on the ostial valve, in the case of total valve absence and in cases showing insufficiency of the first vein wall valve.