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Tauraginskii RA, Lurie F, Simakov S, Agalarov R, Borsuk D, Khramtsov P. Calf muscle pump pressure-flow cycle during ambulation. J Vasc Surg Venous Lymphat Disord 2023; 11:783-792.e7. [PMID: 37068709 DOI: 10.1016/j.jvsv.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 04/03/2023] [Accepted: 04/06/2023] [Indexed: 04/19/2023]
Abstract
OBJECTIVE Calf muscle pump (CMP) failure contributes to the severity and progression of chronic venous disease. Attempts to improve CMP function through resistance exercise have failed to improve chronic venous disease severity or quality of life, partially because the selection of the type of exercise was based on the assumption that the CMP ejects blood from the intramuscular venous sinuses (VSs), which has never been tested in humans. In the present study, we investigated the real-time changes in the pressure and size of the VS during the entire gait cycle of ambulation. METHODS We studied 12 lower extremities of nine healthy volunteers at rest and while walking on a treadmill at three different speeds (60, 90, and 120 steps/min). The changes in the VS cross-sectional area (CSA) and pressure were measured. Myography of the gastrocnemius muscle (GCM) and anterior tibial muscle (ATM) was used to register muscle activity. The relationship between the phases of the gait cycle and the measured parameters was analyzed using video records of all experiments. RESULTS The observed timing of events was consistent among all limbs studied. At rest, with the participants standing still, the VS pressure and CSA was 70.3 ± 4.2 mm Hg and 23.3 ± 14.6 mm2, respectively. During ambulation, at the first half of the stance, the GCM and ATM eccentrically contract, and the pressure is low (17 ± 8 mm Hg, 20 ± 12 mm Hg, and 29 ± 13 mm Hg at 1, 1.5, and 2 Hz, respectively), and the VS is collapsed. When the heel starts rising (the second half of the stance), the GCM concentrically contracts, the pressure increases, reaching its maximum value (143 ± 37, 134 ± 46, and 128 ± 41 mm Hg), and the VS opens, reaching its maximal size (1.8 ± 1.4 and 2.3 ± 2.2 mm2 at 1 and 1.5 Hz, respectively), followed by collapse of the VS. During the swing phase, the GCM relaxes, and the ATM concentrically contracts, resulting in a rapid decrease in pressure (2.6 ± 4.7, 1.1 ± 6.2, and -4.7 ± 3.2 mm Hg). The VS CSA remained negligible. CONCLUSIONS The GCM concentric contraction was associated with a simultaneous increase in VS pressure and CSA. GCM relaxation with ATM concentric contraction coincided with a decrease in VS pressure to negative values. The VSs do not fill but remain empty during the swing phase of ambulation, acting, not as a reservoir, but as a conduit, transferring blood from the network of intramuscular veins to the axial deep veins.
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Affiliation(s)
- Roman A Tauraginskii
- Research Laboratory of Venous Hemodynamics, Phlebocenter LLC, Kaliningrad, Russia.
| | - Fedor Lurie
- Department of Vascular Surgery, Jobst Vascular Institute, Toledo, OH; Division of Vascular Surgery, University of Michigan, Ann Arbor, MI
| | | | | | - Denis Borsuk
- Clinic of Phlebology and Laser Surgery, VenoClinica, Yekaterinburg, Russia
| | - Pavel Khramtsov
- Research Laboratory of Venous Hemodynamics, Phlebocenter LLC, Kaliningrad, Russia
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Mateus S, Paulo R, Coelho P, Rodrigues F, Marques V, Neiva HP, Duarte-Mendes P. Evaluation of Lower Limb Arteriovenous Diameters in Indoor Soccer Athletes: Arterial Doppler Ultrasound Study. Front Physiol 2021; 12:687613. [PMID: 34262477 PMCID: PMC8273383 DOI: 10.3389/fphys.2021.687613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 05/10/2021] [Indexed: 11/17/2022] Open
Abstract
The purpose of this study was to analyze the arterial and venous diameters of lower limbs in indoor soccer athletes and non-athletes using Doppler ultrasound to identify the differences in the variation of arterial and venous diameters between groups. Additionally, we intended to verify the differences of arterial and venous diameters between the skilled member (right member) and the not skilled member in each group. 74 male volunteers, aged between 19 and 30 years old, were divided in a group of athletes (n = 37, 24 ± 2.7 years, soccer players from national championship), and a group of non-athletes (n = 37, 26 ± 2.83 years). Vascular lower limb was assessed using Doppler ultrasound (Philips HD7 echograph with linear transducer 7–12 MHz). The athletes showed higher diameters of right common femoral artery (p = 0.009; moderate), left common femoral artery (p = 0.005; moderate), right deep femoral artery (p = 0.013; moderate), right popliteal artery (p = 0.003; moderate), and left popliteal artery (p = 0.017; small) than non-athletes. Veins’ diameters were also higher in athletes, specifically the right deep femoral vein (p ≤ 0.001; large), left deep femoral vein (p ≤ 0.001; large), right popliteal vein (p ≤ 0.001; large), and left popliteal vein (p ≤ 0.001; large). Differences were found between the skilled and non-skilled leg in athletes in the popliteal vein (7.68 ± 1.44 mm vs. 7.22 ± 1.09 mm, respectively, p < 0.003). It seems that futsal athletes have superior mean diameters of lower limbs arteries and veins of the deep venous system to non-athletes. Moreover, the veins presented greater dilation, namely of the leg of the skilled lower limb.
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Affiliation(s)
- Sónia Mateus
- EPE-Neurovascular and Cardíac Ultrasound Lab, Espiríto Santo of Évora Hospital, Évora, Portugal.,Sport, Health and Exercise Research Unit, Polytechnic Institute of Castelo Branco, Castelo Branco, Portugal.,Department of Clinical Physiology, Polytechnic Institute of Castelo Branco, Castelo Branco, Portugal
| | - Rui Paulo
- Sport, Health and Exercise Research Unit, Polytechnic Institute of Castelo Branco, Castelo Branco, Portugal.,Department of Sports and Well-being, Polytechnic Institute of Castelo Branco, Castelo Branco, Portugal.,Research Unit in Education and Community Intervention, Viseu, Portugal
| | - Patrícia Coelho
- Sport, Health and Exercise Research Unit, Polytechnic Institute of Castelo Branco, Castelo Branco, Portugal.,Department of Clinical Physiology, Polytechnic Institute of Castelo Branco, Castelo Branco, Portugal.,Quality of Life in the Rural World, Polytechnic Institute of Castelo Branco, Castelo Branco, Portugal
| | - Francisco Rodrigues
- Sport, Health and Exercise Research Unit, Polytechnic Institute of Castelo Branco, Castelo Branco, Portugal.,Quality of Life in the Rural World, Polytechnic Institute of Castelo Branco, Castelo Branco, Portugal.,Department Biomedical Sciences Laboratory, Polytechnic Institute of Castelo Branco, Castelo Branco, Portugal
| | - Vasco Marques
- Vascular Ultrasound Laboratory, Angiology and Vascular Surgery Service, Northern Lisbon University Hospital Centre, Lisbon, Portugal
| | - Henrique P Neiva
- Department of Sport Sciences, University of Beira Interior, Covilhã, Portugal.,Research Center in Sports Sciences, Health Sciences and Human Development, CIDESD, Covilhã, Portugal
| | - Pedro Duarte-Mendes
- Sport, Health and Exercise Research Unit, Polytechnic Institute of Castelo Branco, Castelo Branco, Portugal.,Department of Sports and Well-being, Polytechnic Institute of Castelo Branco, Castelo Branco, Portugal.,Research Unit in Education and Community Intervention, Viseu, Portugal
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Mestre S, Triboulet J, Demattei C, Veye F, Nou M, Pérez-Martin A, Dauzat M, Quéré I. Acute effects of graduated and progressive compression stockings on leg vein cross-sectional area and viscoelasticity in patients with chronic venous disease. J Vasc Surg Venous Lymphat Disord 2021; 10:186-195.e25. [PMID: 33964512 DOI: 10.1016/j.jvsv.2021.03.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 03/05/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To determine the effects of graduated and progressive elastic compression stockings (ECS) on postural diameter changes and viscoelasticity of leg veins in healthy controls and in limbs with chronic venous disease (CVD). METHODS In 57 patients whose legs presented with C1S, C3, or C5 CEAP classes of CVD and treated primarily with compression, and 54 healthy controls matched for age and body mass index, we recorded interface pressures at 9 reference leg levels. Cross-sectional areas of the small saphenous vein (SSV) and a deep calf vein (DCV) were measured with B-mode ultrasound with subjects supine and standing, recording the force (PF) applied on the ultrasound probe to collapse each vein with progressive ECS, and with and without graduated 15‒20 mmHg and 20‒36 mmHg elastic stockings. We chose these veins because they were free of detectable lesion and could be investigated at the same level (mid-height of the calf), while their compression by the ultrasound probe was not hampered by bone structures. RESULTS Interface pressures decreased from ankle to knee with graduated 15‒20 and 20‒36 mmHg, but increased with progressive ECS, and were 8.4‒13.8 mmHg lower for C1s than for control or C3 and C5 limbs. Without ECS, SSV median [lower‒upper quartile] cross-sectional area was 4.9[3.6‒7.1] and 7.1[3.0‒9.9]mm2 in C3 and C5 limbs vs. 2.9[1.8‒5.2] and 3.8[2.1‒5.4]mm2 in controls (p<.01), respectively while supine and standing. It remained greater in C3 and C5 than in C1S and control limbs wearing any ESC. Wearing compression, especially with progressive ECS, decreased SSV and DCV cross-sectional area only with subjects supine, thus lowering postural changes which remained highly diverse between individuals. The SSV cross-sectional area vs. PF function traced a hysteresis loop of which the area, related to viscosity, was greater in C3 and C5 limbs than controls, even with graduated 15‒20 or 20‒36 mmHg ECS. Progressive ECS lowered vein viscosity in the supine position whereas 20‒36 mm Hg and progressive ECS increased distensibility in the standing position. CONCLUSION Elastic compression stockings reduce cross-sectional area of superficial and deep calf veins with patients supine but not upright. C1s limbs show distinctive features, especially regarding interface pressures. Graduated 20‒36 mm Hg and progressive stockings lower viscosity and increase distensibility of the small saphenous vein.
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Affiliation(s)
- Sandrine Mestre
- Department of Vascular Medicine, Montpellier University, Montpellier, France; EA2992, Montpellier University, Montpellier, France.
| | | | | | - Florent Veye
- LIRMM, Montpellier University, Montpellier, France
| | - Monira Nou
- Department of Vascular Medicine, Montpellier University, Montpellier, France
| | - Antonia Pérez-Martin
- EA2992, Montpellier University, Montpellier, France; Department of Vascular Medicine, Nimes University Hospital, Numbes, France
| | - Michel Dauzat
- EA2992, Montpellier University, Montpellier, France; Department of Vascular Medicine, Nimes University Hospital, Numbes, France
| | - Isabelle Quéré
- Department of Vascular Medicine, Montpellier University, Montpellier, France; EA2992, Montpellier University, Montpellier, France
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Rusinovich Y, Rusinovich V. Respiratory changes in biometry of suprarenal inferior vena cava in patients with varicose veins of lower extremities. Phlebology 2020; 36:313-321. [PMID: 33201763 DOI: 10.1177/0268355520974135] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM This study examines respiratory biometry of inferior vena cava in patients with varicose veins of lower extremities. MATERIAL AND METHODS We performed retrospective analysis of clinical and ultrasound data of 67 patients with primary varicose veins. RESULTS The largest expiratory (mean 16.2 mm, p-value 0.09) and inspiratory (mean 8.2 mm, p-value 0.02) inferior vena cava diameters were in C3 Clinical Etiological Anatomical Pathophysiological clinical class; the smallest expiratory diameters (mean 13.1 mm, p-value 0.5) were in C6 class; the smallest inspiratory diameters (mean 4.6 mm, intercept) were in C2 class. C2 class was associated with highest inferior vena cava collapsibility index (mean 68.2%, intercept); C6 class was associated with lowest collapsibility index (mean 48.3%, p-value 0.04).Recurrent varices in comparison with previously untreated were associated with smaller inspiratory diameters of inferior vena cava (mean 4.4 mm, p-value 0.005), smaller expiratory diameters (mean 13.4 mm, p-value 0.06) and higher collapsibility index (mean 68.5%, p-value 0.005). Patients with recurrent and bilateral varicose veins had identical respiratory biometry of inferior vena cava.Older age was associated with smaller inferior vena cava diameters (p-value <0.01). CONCLUSION Clinical presentation of varicose veins is associated with different respiratory biometry of suprarenal inferior vena cava. C6 clinical class in comparison with C2 clinical class is associated with lower central venous compliance possible due to the narrowing of inferior vena cava. Smaller inferior vena cava diameters and higher collapsibility index in recurrent subgroup in comparison with previously untreated can be a sign of the significantly altered pressure gradient between the systemic capillaries and the right heart and impaired peripheral venous return. Narrowing of inferior vena cava with age can be a sign of more profound changes in systemic venous return with age in patients with varicose veins in comparison to those without chronic venous disease.
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Affiliation(s)
- Yury Rusinovich
- Department of Vascular Surgery, University Hospital Leipzig, Leipzig, Germany.,Department of Vascular Surgery, Krankenhausgesellschaft Sankt Vincenz GmbH, Limburg, Germany
| | - Volha Rusinovich
- Institute of Hygiene and Environmental Medicine, University Hospital Leipzig, Leipzig, Germany
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Rusinovich Y, Rusinovich V. Association between right heart diastolic function and clinical presentation of chronic venous disease and primary varicose veins of lower extremities. Phlebology 2020; 35:513-519. [DOI: 10.1177/0268355520901903] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aim This study examines the association between right heart diastolic function and clinical presentation of chronic venous disease and primary varicose veins of lower extremities. Material and methods We performed retrospective analysis of clinical, peripheral venous Duplex and tricuspid Doppler (early diastolic inflow E-wave, late diastolic inflow A-wave, ratios of E to A waves, early diastolic annular e′-wave, late diastolic annular a′-wave and systolic annular s′- wave) data of 85 patients, 133 legs with primary varicose veins. Results We found following significant (p-value < 0.05) associations between tricuspid Doppler and clinical presentation of chronic venous disease and primary varicose veins: Clinical Etiological Anatomical Pathophysiological clinical class influenced late diastolic inflow velocities (C6 class A-wave +11.2 cm/s or +27% in comparison with C2), late diastolic annular velocities (C6 class a′-wave +3.3 cm/s or +22% in comparison with C2), systolic annular velocities (C6 class s′-wave +3.7 cm/s or +27% in comparison with C2) and E/A ratios (C6 class E/A ratio −0.22 or −21% in comparison with C2). Recurrent varices in comparison with previously untreated are associated with significantly lower late diastolic inflow velocities (A-wave −4.4 cm/s or −9%) and preserved E/A ratios. Age significantly influenced tricuspid Doppler (E-, A-, e′-, a′-waves and E/A ratios) in patients with chronic venous disease. Conclusion Clinical presentation of primary varicose veins and chronic venous disease can be associated with the right heart diastolic function: C6 Clinical Etiological Anatomical Pathophysiological class in comparison with C2 is associated with increased right ventricular filling and impaired ventricular relaxation – right heart diastolic dysfunction; recurrent varices in comparison with previously untreated are associated with reduced right ventricular filling and preserved right heart diastolic function. Older age is the most important risk factor for varicose veins and chronic venous disease possible due to significant changes in right ventricular filling and in right heart diastolic function with age.
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Affiliation(s)
- Yury Rusinovich
- Department of Vascular Surgery, Krankenhausgesellschaft Sankt Vincenz GmbH, Limburg, Germany
- Department of Vascular Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Volha Rusinovich
- Department of Postgraduate Medical Education, Biermann Verlag GmbH, Koln, Germany
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Chauveau M, Fullana JM, Gelade P, Vicaut E, Flaud P. Simulation numérique de l’œdème veinolymphatique et des effets de la compression. ACTA ACUST UNITED AC 2011; 36:9-15. [DOI: 10.1016/j.jmv.2010.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2010] [Accepted: 10/26/2010] [Indexed: 10/18/2022]
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Pieper B, Templin TN, Kirsner RS, Birk TJ. Impact of injection drug use on distribution and severity of chronic venous disorders. Wound Repair Regen 2009; 17:485-91. [PMID: 19614913 DOI: 10.1111/j.1524-475x.2009.00513.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We examined chronic venous disorders (CVD) in persons who injected illicit drugs. The study design was cross-sectional, comparative stratified by age, gender, ethnicity, as well as by three types of drug use (noninjection; arm or upper body injection only; and legs with or without upper body injection). Subjects completed demographic, health, and substances abuse questionnaires and were evaluated using the clinical component of the Clinical-Etiology-Anatomy-Pathophysiology Classification. Seven hundred and thirteen participants were evaluated. Those who injected in the legs +/- arms had significantly worse CVD. Thirty-nine percent of leg +/- arm injectors vs. 4.2% or noninjectors or arm only injectors had moderate to severe CVD. Persons who injected in the legs +/- arms were 9.14 times more likely to develop venous ulcers than those that injected in the arms and upper body only and 34.64 times more likely as those who never injected. CVD was associated with injecting in the groin, legs and feet as compared with other sites. The pattern of disorders associated with leg injection is consistent with the underlying pathology of chronic venous insufficiency.
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Affiliation(s)
- Barbara Pieper
- College of Nursing, Wayne State University, Detroit, Michigan 48202, USA.
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Abstract
Many older people living at home or in residential settings in the community suffer from inflammation of the skin of the lower legs, or venous eczema. Management of this condition may depend on the background of the professional who carries out the initial assessment. Those with a tissue viability background may plan their care based on an assessment of the patient for suitability for compression, to reverse the venous hypertension which may be a causative factor of the eczema. On the other hand, professionals with a background in dermatology may base initial care plans on the use of emollients and topical steroids to reduce inflammation. This article examines the evidence base for our understanding of what causes venous eczema, questions whether current management of the condition is truly evidence-based, and argues for a more pro-active approach to both assessment and management of venous eczema.
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