Hemodynamic deterioration in chronic venous disease

Welkie, John F.; Comerota, Anthony J.; Katz, Mira L.; Aldridge, Samuel C.; Kerr, Robb P.; White, John V.

doi:10.1016/0741-5214(92)90228-z

Cited by 111 publications

(54 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Clinically, chronic venous diseases like iliofemoral deep vein thrombosis and valvular dysfunction, which are accompanied by varicosities, edemas, pigmentation, and so on, induce venous hypertension (1,23,36,39,52). These diseases are clinically rather common and, therefore, venous hypertension should occur frequently.…”

Section: Discussionmentioning

confidence: 99%

“…When compared at the same pressures, the external diameter was larger and the wall distensibility was smaller in the tilt animals than in the age-matched, nontilt animals, although there was no difference in the wall thickness between them. Clinically, chronic venous diseases like iliofemoral deep vein thrombosis and valvular dysfunction, which are accompanied by varicosities, edemas, pigmentation, and so on, induce venous hypertension (1,23,36,39,52). Appling an indirect method to the patients having such chronic venous insufficiency as a combination of reflux and obstruction, Neglen and Raju (35) observed that the femoral and the popliteal veins, which were most likely exposed to high blood pressure, were less compliant than those in normal, healthy patients.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Biomechanical response of femoral vein to chronic elevation of blood pressure in rabbits

Hayashi

Mori

Miyazaki

2003

American Journal of Physiology-Heart and Circulatory Physiology

View full text Add to dashboard Cite

response of femoral vein to chronic elevation of blood pressure in rabbits. Am J Physiol Heart Circ Physiol 284: H511-H518, 2003. First published September 26, 2002 10.1152/ajpheart.00620.2002-Venous diseases like iliofemoral deep vein thrombosis and valvular dysfunction induce venous hypertension. To know the effects of the hypertension on venous mechanics, blood pressure in the left femoral vein in the rabbit was chronically elevated by the constriction of the left external iliac vein. Wall dimensions and biomechanical properties of the femoral vein were studied in vitro at 1, 2, or 4 wk after surgery. Blood pressure measured immediately before the animal was killed was significantly higher in the left femoral vein than in the sham-operated, contralateral vein. Wall thickness was increased by blood pressure elevation even at 1 wk, which restored circumferential wall stress to a control level. The stress was kept at normal up to 4 wk. Vascular tone and vascular contractility were increased by the elevation of blood pressure; however, wall elasticity and compliance were kept at a normal level. These results are very similar to those observed in hypertensive arteries, indicating that not only arteries but veins optimally operate against blood pressure elevation.hypertrophy; remodeling; wall stress MANY EXPERIMENTAL STUDIES and clinical observations have shown that arteries change their dimensions and properties in response to the chronic elevation of blood pressure (10,14,16,17,19,41). One of the specific biomechanical phenomena appearing in response to arterial hypertension is wall thickening, which restores wall hoop stress to a normal, control level. In addition, vascular tone is increased, although arterial elasticity at in vivo working pressure changes to an optimal level. For example, Matsumoto and Hayashi (26,27) demonstrated in the rat with induced Goldblatt hypertension that the aortic hoop stress at in vivo systolic pressure, which should have been high soon after the induction of hypertension, was rapidly (within 2 wk) restored to a physiologically normal level because of wall hypertrophy and remained at the normal level thereafter. On one hand, the elastic modulus of the wall, which was also high soon after the induction of hypertension, became normal after a relatively long period of time, i.e., at 16 wk. In addition, Fridez et al. (8,9) have shown that normal vascular tone related to the smooth muscle cell, which is the sensing and effecting element of the adaptation process, was increased during the early phase of arterial adaptation to hypertension.As far as we know only Monos et al. (30,32) directly studied the biomechanical effects of the chronic elevation of blood pressure in the vein, and much less is known about the remodeling of the venous wall compared with arteries. They chronically increased blood pressure in the vein of the lower extremity by exposing rats to head-up tilt for 2 wk, and they studied the pressure-diameter relations and wall thickness of the saphenous vein excised from t...

show abstract

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Biomechanical response of femoral vein to chronic elevation of blood pressure in rabbits

Hayashi

Mori

Miyazaki

2003

American Journal of Physiology-Heart and Circulatory Physiology

View full text Add to dashboard Cite

show abstract

“…3,13,14) Welkie et al described that once brawny edema and hyperpigmentation occur, ulceration generally develops without additional deterioration of the venous hemodynamics. 15) In fact, varicose vein legs with skin lesions but without much venous regurgitation are often found. Hence, since the involvement of increased arterial inflow has been pointed out as a factor associated with worsening of venous congestive syndrome, 16) it is important to remove the effect of the arterial inflow rate from VFIst to investigate the relationship between the amount of venous reflux and clinical severity.…”

Section: Accuracy Of Vfist and Primentioning

confidence: 99%

Accuracy of Venous Filling Index on Standing (VFIst) and Pure Regurgitation Index (PRI), a Novel Index Obtained by Air Plethysmography, for Detecting Venous Reflux

Shiraishi

2015

Annals of Vascular Diseases

View full text Add to dashboard Cite

Objective: To evaluate the accuracy of venous filling index on standing (VFIst) and a new index named pure regurgitation index (PRI), obtained by air plethysmography, for detecting venous reflux. Materials and Methods: One hundred and sixty-one healthy subjects (161 limbs) and 180 varicose vein patients (180 limbs) were investigated. All subjects underwent duplex ultrasonography for verifying venous reflux and air plethysmography to obtain hemodynamic parameters such as VFIst, VFI in the supine position (VFIsu), and the maximum arterial inflow rate. To evaluate the accuracy of VFIst and PRI (= (VFIst -VFIsu)/body mass index), receiver operating characteristics curves were created. Results: The optimal cut-off value, sensitivity, specificity, and area under the curve, obtained from analyzing the receiver operating characteristics curves, of VFIst vs. PRI were 2.058 mL/s vs. 0.059 mL ⋅ m 2 /s ⋅ kg, 93.3% vs. 90.3%, 88.8% vs. 91.3%, and 0.954 vs. 0.964, respectively. Conclusions: This study indicates that while both VFIst and PRI are highly accurate indicators of venous reflux, PRI, which is not affected by the arterial inflow rate and body mass index, is slightly superior to VFIst, especially in subjects with greater body mass index.Keywords: venous filling index, pure regurgitation index, accuracy, air plethysmography, varicose veins However, since VFIst is highly affected by the arterial inflow rate (AIR) and body mass index (BMI), 4) it seems an insufficient indicator for quantifying venous reflux. With this in mind, the aim of this study was to create an original index, termed pure regurgitation index (PRI), which is not affected by AIR and BMI, and to evaluate and compare the accuracy of VFIst and PRI as indicators of venous reflux. Materials and MethodsThe normal group (NG) analyzed in this study comprised 161 ambulatory patients (161 right limbs; 37 men and 124 women; mean age [range], 63.3 [22-88] years) who visited the Shiraishi Vascular Surgery Clinic with various leg complaints from May 2012 to February 2015. These patients underwent physical examination, APG, and duplex ultrasonography (DS) to exclude arterial or venous diseases. Arterial disease was ruled out by palpation of the posterior tibial artery and dorsalis pedis artery. The absence of superficial and deep vein incompetence was verified using DS. The mean (range) BMI of the subjects was 23.6 (15.4-33.8) kg/m 2 . The NG consisted of 32 patients who underwent varicose vein treatment for the left leg, 51 preoperative patients with saphenous type varicose vein in the left leg (no venous reflux in the right leg), 20 patients with orthopedic disease such as osteoarthritis, 33 patients experiencing leg dullness during standing work and evening edema, two patients with previous deep vein thrombosis in the left leg, 12 patients with metabolic syndrome, and 11 patients with only telangiectasias in the right leg. None of the patients had a history of deep vein thrombosis in the right leg.Another 180 patients with unilateral axial reflux in the great saph...

show abstract

“…Uninvolved distal deep veins and superficial collaterals may dilate and become incompetent as well. When reflux and/ or obstruction is present, ambulatory venous hypertension develops and ultimately leads to edema, tissue hypoxia and injury, progressive calf pump dysfunction, subcutaneous fibrosis, and skin ulceration (22)(23)(24)(25).…”

Section: Beyond Pulmonary Embolism: Postthrombotic Syndromementioning

confidence: 99%

Endovascular Interventions for Acute and Chronic Lower Extremity Deep Venous Disease: State of the Art

Sista

Vedantham

Kaufman³

et al. 2015

Radiology

View full text Add to dashboard Cite

Hemodynamic deterioration in chronic venous disease

Cited by 111 publications

References 22 publications

Biomechanical response of femoral vein to chronic elevation of blood pressure in rabbits

Biomechanical response of femoral vein to chronic elevation of blood pressure in rabbits

Accuracy of Venous Filling Index on Standing (VFIst) and Pure Regurgitation Index (PRI), a Novel Index Obtained by Air Plethysmography, for Detecting Venous Reflux

Endovascular Interventions for Acute and Chronic Lower Extremity Deep Venous Disease: State of the Art

Contact Info

Product

Resources

About