Non-invasive pressure measurement of the great saphenous vein in healthy controls and patients with venous insufficiency

Köster, Max; Amann-Vesti, Beatrice; Husmann, Marc; Jacomella, Vincenzo; Meier, Thomas; Jeanneret, Christina; Hafner, Jürg; Thalhammer, Christoph

doi:10.3233/ch-131737

Cited by 6 publications

(3 citation statements)

References 18 publications

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“…Although a standardized process of applying compression has yet to be described in the literature, in this study, one individual supervised all the procedures and measurements to assure a standard protocol among the operators. Further studies that apply the use of a pressure manometer could mitigate this variability; such a pressure manometer has been utilized in other ultrasound-based investigations [21]. In a similar manner, standardizing the maneuver used to obtain the respiratory CI was a challenge as well [22].…”

Section: Discussionmentioning

confidence: 99%

Use of ultrasound-measured internal jugular vein collapsibility index to determine static intracardiac pressures in patients with presumed pulmonary hypertension

Parikh

Spring

Weinberg

et al. 2019

Ann. Intensive Care

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BackgroundBedside ultrasound helps to estimate volume status in critically ill patients and has traditionally relied on diameter, respiratory variation, and collapsibility of the inferior vena cava (IVC) to reflect fluid status. We evaluated collapsibility of the internal jugular vein (IJ) with ultrasound and correlated it with concomitant right heart catheterization (RHC) measurements in patients with presumed pulmonary hypertension.Methods and resultsWe studied 71 patients undergoing RHC for evaluation of pulmonary hypertension. Using two-dimensional ultrasound (Sonosite, Washington, USA), we measured the diameter of the IJ at rest, during respiratory variation, and during manual compression. Collapsibility index during respiration (respiratory CI) and during manual compression (compression CI) was calculated. We correlated mean right atrial pressure (mRAP) and pulmonary artery occlusion pressure (PAOP) defined by RHC measurements with respiratory and compression CI. A secondary goal was examining correlations between CI calculations and B-type natriuretic peptide (BNP) levels. Baseline characteristics demonstrated female predominance (n = 51; 71.8%), mean age 59.5 years, and BMI 27.3. There were significant correlations between decrease in compression CI and increase in both mRAP (Spearman: − 0.43; p value = 0.0002) and PAOP (Spearman: − 0.35; p value = 0.0027). In contrast, there was no significant correlation between respiratory CI and either mRAP (Spearman: − 0.14; p value = 0.35) or PAOP (Spearman:− 0.12; p value = 0.31). We also observed significant negative correlation between compression CI and BNP (Spearman: − 0.31; p value = 0.01) but not between respiratory CI and BNP (Spearman: − 0.12; p value = 0.35).ConclusionIncreasing use of ultrasound has led to innovative techniques for estimating volume status. While prior ultrasound studies have used clinical parameters to estimate fluid status, our study used RHC measurements and demonstrated that compression CI potentially reflects directly measured mRAP and PAOP.

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Section: Discussionmentioning

confidence: 99%

Use of ultrasound-measured internal jugular vein collapsibility index to determine static intracardiac pressures in patients with presumed pulmonary hypertension

Parikh

Spring

Weinberg

et al. 2019

Ann. Intensive Care

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“…Venous transmural pressure in healthy humans is typically around 20 mmHg but can increase to around 60 mmHg during sustained upright posture or in patients with insufficient venous valve function (Koster et al, 2013 ). Maximal active tension development at transmural pressures higher than the physiological level (Figure 1 ) provides basis for a Starling-like mechanism that will limit vein compliance during combined venous build-up of blood and activation of venous smooth muscle cells.…”

Section: Discussionmentioning

confidence: 99%

Increased Contractile Function of Human Saphenous Vein Grafts Harvested by “No-Touch” Technique

et al. 2018

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Saphenous vein grafts are the most common conduits used for coronary artery bypass grafting (CABG); however, no more than 60% of vein grafts remain open after 10 years and graft failure is associated with poor clinical outcome. The “no-touch” harvesting technique—where a sheet of perivascular tissue is retained around the vein—improves graft patency to over 80% after 16 years of follow-up, but the mechanism for the improved patency rate is unclear. In this study, we investigated acute functional differences between vein grafts harvested conventionally and by “no-touch” technique and explored the importance of perivascular tissue for reducing surgical trauma, minimizing excessive distension, and releasing vasoactive paracrine factors. Segments of human saphenous veins were obtained from CABG surgery and their functional properties investigated by isometric and isobaric myography. We found a broad diameter-tension relationship for human saphenous veins, with peak capacity for active tension development at diameters corresponding to transmural pressures around 60 mmHg. Across the investigated transmural pressure range between 10 and 120 mmHg, maximal tension development was higher for “no-touch” compared to conventionally harvested saphenous veins. Contractile responses to serotonin, noradrenaline, and depolarization induced with elevated extracellular [K+] were significantly larger for saphenous veins harvested by “no-touch” compared to conventional technique. Conventional vein grafts are routinely pressurized manually in order to test for leaks; however, avoiding this distension procedure did not change the acute contractile function of the conventionally excised saphenous veins. In contrast, even though surgical removal of perivascular tissue during conventional harvesting was associated with a substantial decrease in force development, removal of perivascular tissue by careful dissection under a stereomicroscope only marginally affected contractile responses of veins harvested by “no-touch” technique. In conclusion, we show that saphenous veins harvested by “no-touch” technique have greater contractile capacity than veins harvested by conventional technique. The different capacity for smooth muscle contraction is not due to vasoactive substances released by the perivascular tissue. Instead, we propose that the larger tension development of saphenous veins harvested by “no-touch” technique reflects reduced surgical damage, which may have long-term consequences that contribute to the superior graft patency.

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“…There are other non-invasive techniques used to estimate central venous pressure that were not evaluated in this study. These include the use of controlled compression ultrasound evaluation of the great saphenous or peripheral arm veins [55] – [57] . Uthoff and colleagues prospectively studied the utility of forearm vein collapse evaluation in critically ill patients with an already indwelling central venous catheter measuring CVPs [57] .…”

Section: Discussionmentioning

confidence: 99%

Non-Invasive Bedside Assessment of Central Venous Pressure: Scanning into the Future

et al. 2014

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BackgroundNoninvasive evaluation of central venous pressure (CVP) can be achieved by assessing the Jugular Venous Pressure (JVP), Peripheral Venous Collapse (PVC), and ultrasound visualization of the inferior vena cava. The relative accuracy of these techniques compared to one another and their application by trainees of varying experience remains uncertain. We compare the application and utility of the JVP, PVC, and handheld Mini Echo amongst trainees of varying experience including a medical student, internal medicine resident, and cardiology fellow. We also introduce and validate a new physical exam technique to assess central venous pressures, the Anthem sign.MethodsPatients presenting for their regularly scheduled echocardiograms at the hospital echo department had clinical evaluations of their CVP using these non-invasive bedside techniques. The examiners were blinded to the echo results, each other's assessments, and patient history; their CVP estimates were compared to the gold standard level 3 echo-cardiographer's estimates at the completion of the study.Results325 patients combined were examined (mean age 65, s.d. 16 years). When compared to the gold standard of central venous pressure by a level 3 echocardiographer, the JVP was the most sensitive at 86%, improving with clinical experience (p<0.01). The classic PVC technique and Anthem sign had better specificity compared to the JVP. Mini Echo estimates were comparable to physical exam assessments.ConclusionsJVP evaluation is the most sensitive physical examination technique in CVP assessments. The PVC techniques along with the newly described Anthem sign may be of value for the early learner who still has not mastered the art of JVP assessment and in obese patients in whom JVP evaluation is problematic. Mini Echo estimates of CVPs are comparable to physical examination by trained clinicians and require less instruction. The use of Mini Echo in medical training should be further evaluated and encouraged.

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Non-invasive pressure measurement of the great saphenous vein in healthy controls and patients with venous insufficiency

Cited by 6 publications

References 18 publications

Use of ultrasound-measured internal jugular vein collapsibility index to determine static intracardiac pressures in patients with presumed pulmonary hypertension

Use of ultrasound-measured internal jugular vein collapsibility index to determine static intracardiac pressures in patients with presumed pulmonary hypertension

Increased Contractile Function of Human Saphenous Vein Grafts Harvested by “No-Touch” Technique

Non-Invasive Bedside Assessment of Central Venous Pressure: Scanning into the Future

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