Hemodynamic assessement of chronic venous insufficiency

Abstract

To study the pathogenesis of chronic venous insufficiency (CVI), photoplethysmography and strain-gauge plethysmography were simultaneously performed in 84 patients. Of the 128 limbs studied, 24 were normal, 64 had primary varicose veins and 40 had post-thrombotic syndrome. Venography was also performed in all patients. The results of this study indicate that reflux in the superficial veins is the main pathophysiology involved in the development of CVI, though incompetence of the perforators and deep veins plays some role. In post-thrombotic syndrome, however, CVI is mainly a sequel of deep venous incompetence, the condition being complicated by incompetent perforators and superficial venous reflux.

Evaluation of Compression under an Elastic Tubular Bandage Utilised as an Introduction to Compression Therapy in the Treatment of Venous Leg Ulcers

“…The median (range) age of the 6 volunteers (2 men, 4 women) was 39 (29-52) years. The median (range) of the sub-bandage pressures recorded for the three-layer Tubigrip bandage at the origin of the Achilles tendon, mid-calf and the upper border of the calf muscle for the 6 volunteers while sitting with legs dependent were 26 (19-32), 25 (16-31) and 12.5 (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22) mmHg, and for standing were 32 (24-40), 40 (27--47) and 16 (8-28) mmHg (Fig. 3).…”

“…There is a large body of evidence that associates venous ulceration with high ambulatory venous pressures in the subcutaneous veins of the lower leg. This may arise due to valvular incompetence [8][9][10]. Incompetent valves result in the partial or complete failure of the venous calf muscle pump [11].…”

“…Incompetent valves result in the partial or complete failure of the venous calf muscle pump [11]. The high venous pressures associated with this failure disrupt the local blood circulation within the lower leg, affecting both the macro-and microcirculation [8,12,13], the microcirculation being increased. Compression therapy is thought to correct or relieve this incompetence.…”

Measurement of the skin microcirculation through intact bandages using laser Doppler flowmetry

“…This situation can arise owing to valvular incompetence (ALAM et al, 1991;WELKIE et al, 1991;BURNAND et al, 1977), resulting in partial or complete failure of the venous calf muscle pump (STEMMER, 1971). The high venous pressures associated with this failure can disrupt the local blood circulation within the lower leg, affecting both the macro (ALAM et al, 1991) and microcirculation (CREUTZlG et al, 1994;BELCARO and NICOLAIDES, 1994).…”

Effect of compression on blood flow in lower limb wounds

“…Blood flow is believed to be a key parameter in the formation and management of lower limb wounds. In venous leg ulcer (VLU) patients, the presence of high ambulatory venous pressure in the veins of the lower leg may be caused by valvular incompetence (1–3) which in turn results in the partial or complete failure of the calf muscle pump (4). The high venous pressures associated with this failure disturb the local blood circulation within the lower limb, affecting both macro‐ and microcirculation (1,5,6).…”