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Abstract
Blood rheology is a challenging subject owing to the fact that blood is a mixture of a fluid (plasma) and of cells, among which red blood cells make about 50% of the total volume. It is precisely this circumstance that originates the peculiar behavior of blood flow in small vessels (i.e., roughly speaking, vessel with a diameter less than half a millimeter). In this class we find arterioles, venules, and capillaries. The phenomena taking place in microcirculation are very important in supporting life. Everybody knows the importance of blood filtration in kidneys, but other phenomena, of not less importance, are known only to a small class of physicians. Overviewing such subjects reveals the fascinating complexity of microcirculation.
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Lyons O, Saha P, Seet C, Kuchta A, Arnold A, Grover S, Rashbrook V, Sabine A, Vizcay-Barrena G, Patel A, Ludwinski F, Padayachee S, Kume T, Kwak BR, Brice G, Mansour S, Ostergaard P, Mortimer P, Jeffery S, Brown N, Makinen T, Petrova TV, Modarai B, Smith A. Human venous valve disease caused by mutations in FOXC2 and GJC2. J Exp Med 2020; 214:2437-2452. [PMID: 28724617 PMCID: PMC5551565 DOI: 10.1084/jem.20160875] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 04/26/2017] [Accepted: 06/09/2017] [Indexed: 01/28/2023] Open
Abstract
Venous valves (VVs) prevent venous hypertension and ulceration. We report that FOXC2 and GJC2 mutations are associated with reduced VV number and length. In mice, early VV formation is marked by elongation and reorientation ("organization") of Prox1hi endothelial cells by postnatal day 0. The expression of the transcription factors Foxc2 and Nfatc1 and the gap junction proteins Gjc2, Gja1, and Gja4 were temporospatially regulated during this process. Foxc2 and Nfatc1 were coexpressed at P0, and combined Foxc2 deletion with calcineurin-Nfat inhibition disrupted early Prox1hi endothelial organization, suggesting cooperative Foxc2-Nfatc1 patterning of these events. Genetic deletion of Gjc2, Gja4, or Gja1 also disrupted early VV Prox1hi endothelial organization at postnatal day 0, and this likely underlies the VV defects seen in patients with GJC2 mutations. Knockout of Gja4 or Gjc2 resulted in reduced proliferation of Prox1hi valve-forming cells. At later stages of blood flow, Foxc2 and calcineurin-Nfat signaling are each required for growth of the valve leaflets, whereas Foxc2 is not required for VV maintenance.
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Affiliation(s)
- Oliver Lyons
- Academic Department of Vascular Surgery, Cardiovascular Division, BHF Centre of Research Excellence, King's College London, St Thomas' Hospital, London, England, UK
| | - Prakash Saha
- Academic Department of Vascular Surgery, Cardiovascular Division, BHF Centre of Research Excellence, King's College London, St Thomas' Hospital, London, England, UK
| | - Christopher Seet
- Academic Department of Vascular Surgery, Cardiovascular Division, BHF Centre of Research Excellence, King's College London, St Thomas' Hospital, London, England, UK
| | - Adam Kuchta
- Department of Ultrasonic Angiology, Guy's and St Thomas' NHS Foundation Trust, London, England, UK
| | - Andrew Arnold
- Department of Ultrasonic Angiology, Guy's and St Thomas' NHS Foundation Trust, London, England, UK
| | - Steven Grover
- Division of Hemostasis and Thrombosis, Beth Israel Deaconess Medical Center, Boston, MA.,Harvard Medical School, Boston, MA
| | - Victoria Rashbrook
- Academic Department of Vascular Surgery, Cardiovascular Division, BHF Centre of Research Excellence, King's College London, St Thomas' Hospital, London, England, UK
| | - Amélie Sabine
- Department of Fundamental Oncology, Ludwig Institute for Cancer Research, Zurich, Switzerland.,Division of Experimental Pathology, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Epalinges, Switzerland
| | - Gema Vizcay-Barrena
- Center for Ultrastructural Imaging, King's College London, London, England, UK
| | - Ash Patel
- Academic Department of Vascular Surgery, Cardiovascular Division, BHF Centre of Research Excellence, King's College London, St Thomas' Hospital, London, England, UK
| | - Francesca Ludwinski
- Academic Department of Vascular Surgery, Cardiovascular Division, BHF Centre of Research Excellence, King's College London, St Thomas' Hospital, London, England, UK
| | - Soundrie Padayachee
- Department of Ultrasonic Angiology, Guy's and St Thomas' NHS Foundation Trust, London, England, UK
| | - Tsutomu Kume
- Feinberg Cardiovascular Research Institute, Northwestern University School of Medicine, Evanston, IL
| | - Brenda R Kwak
- Department of Pathology and Immunology, University of Geneva, Geneva, Switzerland
| | - Glen Brice
- South West Thames Regional Genetics Service, St George's Hospital, London, England, UK
| | - Sahar Mansour
- South West Thames Regional Genetics Service, St George's Hospital, London, England, UK
| | - Pia Ostergaard
- Cardiovascular and Cell Sciences Institute, St George's Hospital, London, England, UK
| | - Peter Mortimer
- Cardiovascular and Cell Sciences Institute, St George's Hospital, London, England, UK
| | - Steve Jeffery
- Cardiovascular and Cell Sciences Institute, St George's Hospital, London, England, UK
| | - Nigel Brown
- Institute of Medical and Biomedical Education, St George's Hospital, London, England, UK
| | - Taija Makinen
- Rudbeck Laboratory, Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Tatiana V Petrova
- Department of Fundamental Oncology, Ludwig Institute for Cancer Research, Zurich, Switzerland.,Division of Experimental Pathology, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Epalinges, Switzerland
| | - Bijan Modarai
- Academic Department of Vascular Surgery, Cardiovascular Division, BHF Centre of Research Excellence, King's College London, St Thomas' Hospital, London, England, UK
| | - Alberto Smith
- Academic Department of Vascular Surgery, Cardiovascular Division, BHF Centre of Research Excellence, King's College London, St Thomas' Hospital, London, England, UK
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Liu X, Liu L. Effect of valve lesion on venous valve cycle: A modified immersed finite element modeling. PLoS One 2019; 14:e0213012. [PMID: 30830909 PMCID: PMC6398833 DOI: 10.1371/journal.pone.0213012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 02/13/2019] [Indexed: 01/21/2023] Open
Abstract
The present study aimed to understand the effect of venous valve lesion on the valve cycle. A modified immersed finite element method was used to model the blood–tissue interactions in the pathological vein. The contact process between leaflets or between leaflet and sinus was evaluated using an adhesive contact method. The venous valve modeling was validated by comparing the results of the healthy valve with those of experiments and other simulations. Four valve lesions induced by the abnormal elasticity variation were considered for the unhealthy valve: fibrosis, atrophy, incomplete fibrosis, and incomplete atrophy. The opening orifice area was inversely proportional to the structural stiffness of the valve, while the transvalvular flow velocity was proportional to the structural stiffness of the valve. The stiffening of the fibrotic leaflet led to a decrease in the orifice area and a stronger jet. The leaflet and blood wall shear stress (WSS) in fibrosis was the highest. The softening of the atrophic leaflet resulted in overly soft behavior. The venous incompetence and reflux were observed in atrophy. Also, the atrophic leaflet in incomplete atrophy exhibited weak resistance to the hemodynamic action, and the valve was reluctant to be closed owing to the large rotation of the healthy leaflet. Low blood WSS and maximum leaflet WSS existed in all the cases. A less biologically favorable condition was found especially in the fibrotic leaflet, involving a higher mechanical cost. This study provided an insight into the venous valve lesion, which might help understand the valve mechanism of the diseased vein. These findings will be more useful when the biology is also understood. Thus, more biological studies are needed.
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Affiliation(s)
- Xiang Liu
- School of Science, Wuhan University of Technology, Wuhan, China
- Hubei Key Laboratory of Theory and Application of Advanced Materials Mechanics, Wuhan University of Technology, Wuhan, China
| | - Lisheng Liu
- Hubei Key Laboratory of Theory and Application of Advanced Materials Mechanics, Wuhan University of Technology, Wuhan, China
- State Key Laboratory of Advanced Technology of Materials Synthesis and Processing, Wuhan University of Technology, Wuhan, China
- * E-mail:
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Keiler J, Schulze M, Claassen H, Wree A. Human Femoral Vein Diameter and Topography of Valves and Tributaries: A Post Mortem Analysis. Clin Anat 2018; 31:1065-1076. [PMID: 30240062 DOI: 10.1002/ca.23224] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 05/25/2018] [Accepted: 06/05/2018] [Indexed: 11/08/2022]
Abstract
The femoral vein (FV) is a clinically important vessel. Failure of its valves can lead to chronic venous insufficiency (CVI) with severe manifestations such as painful ulcers. Although they are crucial for identifying suitable implant sites for therapeutic valves, studies on the topography of FV tributaries and valves are rare. Moreover, the femoral vein diameter (FVD) must be known to assess the morphometric requirements for valve implants. To reassess the anatomical requirements for valve implants, 155 FVs from 82 human corpses were examined. FVDs and tributary and valve topographies were assessed using a laboratory straightedge. The FVD increased from 6 mm in the distal femoropopliteal vein to 11 mm in the iliofemoral vein proximal to the saphenofemoral junction (SFJ). Diameters were significantly bigger in males than females. Height correlated positively with FVD. Distal to the SFJ, within a distance of 38 cm, one to eight valves were present. Up to two valves were present within 10 cm proximal to the SFJ. Individual tributary and valve topography must be considered to ensure appropriate design and successful implantation of a venous valve for CVI therapy in the FV. A suitable implant site would be proximal to the SFJ via an infrainguinal transfemoral access. Clin. Anat. 31:1065-1076, 2018. © 2018 Wiley Periodicals, Inc.
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Affiliation(s)
- Jonas Keiler
- Department of Anatomy, Rostock University Medical Center, Rostock, Germany
| | - Marko Schulze
- Department of Anatomy, Rostock University Medical Center, Rostock, Germany
| | - Horst Claassen
- Department of Anatomy and Cell Biology, Faculty of Medicine, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Andreas Wree
- Department of Anatomy, Rostock University Medical Center, Rostock, Germany
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Chen HY, Diaz JA, Lurie F, Chambers SD, Kassab GS. Hemodynamics of venous valve pairing and implications on helical flow. J Vasc Surg Venous Lymphat Disord 2018; 6:517-522.e1. [DOI: 10.1016/j.jvsv.2018.02.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 02/01/2018] [Indexed: 10/14/2022]
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Lee SJ, Park JH, Kim JJ, Yeom E. Quantitative Analysis of Helical Flow with Accuracy Using Ultrasound Speckle Image Velocimetry: In Vitro and in Vivo Feasibility Studies. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:657-669. [PMID: 29288000 DOI: 10.1016/j.ultrasmedbio.2017.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 11/10/2017] [Accepted: 11/20/2017] [Indexed: 06/07/2023]
Abstract
Venous valve dysfunction and induced secondary abnormal flows are closely associated with venous diseases. Thus, detailed analysis of venous valvular flow is invaluable from biological and medical perspectives. However, most of the previous studies on venous perivalvular flows were based on qualitative analysis. On the contrary, quantitative analysis of perivalvular flows has not been fully understood. In this study, we used the ultrasound speckle image velocimetry (SIV) technique, which utilizes the speckle patterns of red blood cells (RBCs) created by ultrasound waves to measure 3-D valvular flows quantitatively. The flow structures obtained with the proposed SIV technique for an in vitro model were compared with those obtained by numerical simulation and the color Doppler method to validate the measurement accuracy of the ultrasound SIV technique. Blood flow in the human great saphenous vein was then measured at various distances from the valve with and without exercise. 3-D valvular flow was analyzed in accordance with the dimensionless index, helical intensity. The results obtained by the proposed method matched well with those obtained by numerical simulation and the color Doppler method. The hemodynamic characteristics of 3-D valvular helical flow which were analyzed experimentally using the SIV method would be used for quantitative diagnosis of venous valvular diseases.
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Affiliation(s)
- Sang Joon Lee
- Department of Mechanical Engineering, Pohang University of Science and Technology (POSTECH), Pohang, Republic of Korea.
| | - Jun Hong Park
- Department of Mechanical Engineering, Pohang University of Science and Technology (POSTECH), Pohang, Republic of Korea
| | - Jeong Ju Kim
- Department of Mechanical Engineering, Pohang University of Science and Technology (POSTECH), Pohang, Republic of Korea
| | - Eunseop Yeom
- School of Mechanical Engineering, Pusan National University, Busan, Republic of Korea
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Neuromuscular electrical stimulation reduces sludge in the popliteal vein. J Vasc Surg Venous Lymphat Disord 2017; 6:154-162. [PMID: 29292116 DOI: 10.1016/j.jvsv.2017.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 09/13/2017] [Indexed: 01/24/2023]
Abstract
BACKGROUND The common peroneal nerve stimulator (CPNS) is a UK-approved device for reducing venous thromboembolism (VTE) risk. It resembles a wrist watch and is placed over the common peroneal nerve, discharging electricity at a rate of 1 impulse/s. It has been presumed that as blood flow slows, erythrocytes aggregate into ultrasound-detectable echogenic particles, described as venous sludge. The aim of the study was to determine whether the CPNS reduces venous sludge by using an ultrasound-derived gray-scale (0-255) venous sludge index (VSI). METHODS Twenty-five healthy volunteers had their right popliteal vein video recorded using B-mode ultrasound at 22 frames/s in longitudinal and transverse views, standing and lying. This was performed first with the CPNS off and then with the CPNS on. The CPNS impulse intensity used was set from 1 to 7 for each individual, and the level was sufficient to cause an outward jerking movement of the foot. A single frame of the possible 154 frames, lasting 7 seconds, was selected using a random number generator for the image analysis. The "brightness" of the erythrocyte aggregates (pixels) within a circular sampling area was quantified using the VSI. The brighter the sample, the greater the sludge. RESULTS Values are expressed as median (interquartile range). On standing with the device off, there was a significantly higher VSI (P < .0005) compared with lying (longitudinal view, 27.7 [18.8-41.4] vs 11.7 [5.5-17.5]; transverse view, 20.7 [13.6-32.2] vs 11.4 [6.3-15.9]). Activation of the CPNS significantly reduced all the VSI values (P < .0005) shown (longitudinal view, 2 [1.1-3.2] and 1.5 [0.5-3.1]; transverse view, 1.1 [0.6-2.7] and 0.8 [0.5-2.1]). CONCLUSIONS The CPNS device significantly reduces venous sludge within the popliteal vein irrespective of whether the subject is standing or lying down or of the longitudinal or transverse position of the ultrasound transducer. The principal mode of action of the device in the claim that it may reduce venous thromboembolism risk may be through a reduction of venous sludge. However, the relationship between erythrocyte aggregation, venous stasis, and venous thromboembolism risk requires more investigation.
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Ibrahim N, Abd Aziz NS, Abd Manap AN. Vein mechanism simulation study for deep vein thrombosis early diagnosis using cfd. JOURNAL OF PHYSICS: CONFERENCE SERIES 2017; 822:012040. [DOI: 10.1088/1742-6596/822/1/012040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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Spiral Laminar Flow: a Survey of a Three-Dimensional Arterial Flow Pattern in a Group of Volunteers. Eur J Vasc Endovasc Surg 2016; 52:674-680. [DOI: 10.1016/j.ejvs.2016.07.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 07/16/2016] [Indexed: 11/18/2022]
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Soifer E, Weiss D, Marom G, Einav S. The effect of pathologic venous valve on neighboring valves: fluid-structure interactions modeling. Med Biol Eng Comput 2016; 55:991-999. [PMID: 27663560 DOI: 10.1007/s11517-016-1575-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 09/15/2016] [Indexed: 11/27/2022]
Abstract
Understanding the hemodynamics surrounding the venous valve environment is of a great importance for prosthetic valves design. The present study aims to evaluate the effect of leaflets' stiffening process on the venous valve hemodynamics, valve's failure on the next proximal valve hemodynamics and valve's failure in a secondary daughter vein on the healthy valve hemodynamics in the main vein when both of these valves are distal to a venous junction. Fully coupled, two-way fluid-structure interaction computational models were developed and employed. The sinus pocket region experiences the lowest fluid shear stress, and the base region of the sinus side of the leaflet experiences the highest tissue stress. The leaflets' stiffening increases the tissue stress the valve is experiencing in a very low fluid shear region. A similar effect occurs with the proximal healthy valve as a consequence of the distal valve's failure and with the mother vein valve as a consequence of daughter vein valve's failure. Understanding the described mechanisms may be helpful for elucidating the venous valve stiffness-function relationship in nature, the reasons for a retrograde development of reflux and the relationship between venous valves located near venous junctions, and for designing better prosthetic valves and for improving their positioning.
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Affiliation(s)
- Elina Soifer
- The Department of Biomedical Engineering, Tel-Aviv University, Tel-Aviv, Israel.
| | - Dar Weiss
- The Department of Biomedical Engineering, Tel-Aviv University, Tel-Aviv, Israel
| | - Gil Marom
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, USA
| | - Shmuel Einav
- The Department of Biomedical Engineering, Tel-Aviv University, Tel-Aviv, Israel.,Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, USA
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Transforming the best care into the standard for care. J Vasc Surg Venous Lymphat Disord 2016; 4:106-13. [DOI: 10.1016/j.jvsv.2015.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 10/06/2015] [Indexed: 11/16/2022]
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13
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Harfoush K, Guintard C, Desfontis JC, Thorin C, Douart C, Mallem MY, Betti E. Venous Valvular Distribution in the Thoracic and Pelvic Limbs of the Horse. Anat Histol Embryol 2015; 45:409-417. [DOI: 10.1111/ahe.12209] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 08/21/2015] [Indexed: 11/27/2022]
Affiliation(s)
- K. Harfoush
- Unité d'Anatomie Comparée; Ecole Nationale Vétérinaire; Agroalimentaire et de l'Alimentation Nantes-Atlantique - Oniris; BP 40706 44307 Nantes France
- UPSP 5304 de Physiopathologie Animale et Pharmacologie Fonctionnelle; Ecole Nationale Vétérinaire; Agroalimentaire et de l'Alimentation Nantes-Atlantique - Oniris; BP 40706 44307 Nantes France
| | - C. Guintard
- Unité d'Anatomie Comparée; Ecole Nationale Vétérinaire; Agroalimentaire et de l'Alimentation Nantes-Atlantique - Oniris; BP 40706 44307 Nantes France
| | - J. C. Desfontis
- UPSP 5304 de Physiopathologie Animale et Pharmacologie Fonctionnelle; Ecole Nationale Vétérinaire; Agroalimentaire et de l'Alimentation Nantes-Atlantique - Oniris; BP 40706 44307 Nantes France
| | - C. Thorin
- UPSP 5304 de Physiopathologie Animale et Pharmacologie Fonctionnelle; Ecole Nationale Vétérinaire; Agroalimentaire et de l'Alimentation Nantes-Atlantique - Oniris; BP 40706 44307 Nantes France
| | - C. Douart
- Unité d'Anatomie Comparée; Ecole Nationale Vétérinaire; Agroalimentaire et de l'Alimentation Nantes-Atlantique - Oniris; BP 40706 44307 Nantes France
| | - M. Y. Mallem
- UPSP 5304 de Physiopathologie Animale et Pharmacologie Fonctionnelle; Ecole Nationale Vétérinaire; Agroalimentaire et de l'Alimentation Nantes-Atlantique - Oniris; BP 40706 44307 Nantes France
| | - E. Betti
- Unité d'Anatomie Comparée; Ecole Nationale Vétérinaire; Agroalimentaire et de l'Alimentation Nantes-Atlantique - Oniris; BP 40706 44307 Nantes France
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De Maeseneer M, van der Velden S. Managing Chronic Venous Disease: An Ongoing Challenge. Eur J Vasc Endovasc Surg 2015; 49:676-677. [DOI: 10.1016/j.ejvs.2015.02.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Wittens C, Davies AH, Bækgaard N, Broholm R, Cavezzi A, Chastanet S, de Wolf M, Eggen C, Giannoukas A, Gohel M, Kakkos S, Lawson J, Noppeney T, Onida S, Pittaluga P, Thomis S, Toonder I, Vuylsteke M, Kolh P, de Borst GJ, Chakfé N, Debus S, Hinchliffe R, Koncar I, Lindholt J, de Ceniga MV, Vermassen F, Verzini F, De Maeseneer MG, Blomgren L, Hartung O, Kalodiki E, Korten E, Lugli M, Naylor R, Nicolini P, Rosales A. Editor's Choice - Management of Chronic Venous Disease: Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg 2015; 49:678-737. [PMID: 25920631 DOI: 10.1016/j.ejvs.2015.02.007] [Citation(s) in RCA: 505] [Impact Index Per Article: 56.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Hemodynamic coupling of a pair of venous valves. J Vasc Surg Venous Lymphat Disord 2014; 2:303-14. [DOI: 10.1016/j.jvsv.2013.09.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Revised: 09/09/2013] [Accepted: 09/22/2013] [Indexed: 11/18/2022]
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Abstract
OBJECTIVE To study the anatomy of the veno-muscular pumps of the lower limb, particularly the calf pump, the most powerful of the lower limb, and to confirm its crucial importance in venous return. METHODS In all, 400 cadaveric limbs were injected with green Neoprene latex followed by an anatomical dissection. RESULTS The foot pump is the starter of the venous return. The calf pump can be divided into two anatomical parts: the leg pump located in the veins of the soleus muscle and the popliteal pump ending in the popliteal vein with the unique above-knee collector of the medial gastrocnemial veins. At the leg level, the lateral veins of the soleus are the bigger ones. They drain vertically into the fibular veins. The medial veins of the soleus, smaller, join the posterior tibial veins horizontally. At the popliteal level, medial gastrocnemial veins are the largest veins, which end uniquely as a large collector into the popliteal vein above the knee joint. This explains the power of the gastrocnemial pump: during walking, the high speed of the blood ejection during each muscular systole acts like a nozzle creating a powerful jet into the popliteal vein. This also explains the aspiration (Venturi) effect on the deep veins below. Finally, the thigh pump of the semimembranosus muscles pushes the blood of the deep femoral vein together with the quadriceps veins into the common femoral vein. CONCLUSION The veno-muscular pumps of the lower limb create a chain of events by their successive activation during walking. They play the role of a peripheral heart, which combined with venous valves serve to avoid gravitational reflux during muscular diastole. A stiffness of the ankle or/and the dispersion of the collectors inside the gastrocnemius could impair this powerful pump and so worsen venous return, causing development of severe chronic venous insufficiency.
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Affiliation(s)
| | - Claude Gillot
- URDIA Anatomy Research Unit, Paris Descartes University, Paris
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Lurie F, Kistner RL. On the existence of helical flow in veins of the lower extremities. J Vasc Surg Venous Lymphat Disord 2013; 1:134-8. [DOI: 10.1016/j.jvsv.2012.08.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Revised: 08/14/2012] [Accepted: 08/19/2012] [Indexed: 10/27/2022]
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