Physical exercise for the treatment of non-ulcerated chronic venous insufficiency

Araújo, Daline Fernandes de Souza; Ribeiro, Cléa Elisa Lopes; Maciel, Alvaro Cc; Bruno, Selma S.; Fregonezi, Guilherme A. F.; Dias, Fernando Al

doi:10.1002/14651858.cd010637.pub3

Cited by 3 publications

(2 citation statements)

References 55 publications

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“…16,29 Moreover, attempts to ameliorate CMP function using resistance exercise programs have shown a lack of agreement between clinical outcomes and the results of improved CMP functional parameters. [29][30][31][32][33] The functional tests are based on the assumption that CMP effectiveness is the ability to eject blood from the largest intramuscular veins (venous sinuses [VS]) of the gastrocnemius (GCM) and soleus muscles by their contraction. In turn, to provide blood ejection, VS should be adequately filled with blood between muscle contractions (relaxation phase).…”

Section: Introductionmentioning

confidence: 99%

Human lower leg muscle pump acts like a stream diversion pump during locomotion

Tauraginskii,

Lurie,

Simakov

et al. 2023

Preprint

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BackgroundCalf muscle pump (CMP) failure is associated with the development and progression of chronic venous insufficiency as characterized by ambulatory venous hypertension (AVH). However, the explicit interconnection between AVH with CMP failure remains uncertain because the concept of CMP function is controversial. The study aimed to measure pressure in different segments of the great saphenous vein (GSV) and intramuscular vein of the gastrocnemius (GCM) during exercise.MethodsTwelve legs of nine healthy volunteers were enrolled in the study. Continuous pressure (IVCALF, GSV at ankle, proximal calf, and mid-distal thigh) and electromyography data (GCM and anterior tibial muscle [ATM]) were recorded during treadmill walking, running, and plantar flexion exercises. The pressure gradient (PG, mmHg) between adjacent points of measurement was calculated. Minute unit power of muscle pump ejection and suction (, and, MPa/min) were calculated and compared with the arterial blood supply of the lower extremity (LBF, L/min).ResultsPG demonstrated a consistent pattern of changes during walking and running. An absence of PG directed from the calf to the thigh (centripetal) in the GSV was observed. Instead, a retrograde PG was verified throughout the entire stride cycle. Its value decreased with the increase in stride cycle frequency. The dynamics of PG between the IV and GSV were the following: It was directed from the IV to GSV during GCM contraction and was reversed during ATM contraction and GCM relaxation (swing phase). LBF,, anddemonstrated similar exponential growth with the increase in stride frequency during walking and running.ConclusionsThe pressure gradient in the GSV prevents centripetal flow during locomotion. Instead, PG directs blood flow from the GSV toward intramuscular veins. The increase in CMP unit power was tightly coupled with lower extremity arterial blood supply growth that prevented ambulatory venous pressure rise during exercise.Novelty and Significance What Is Known?The existence of a pressure gradient in superficial veins directed centripetally (from calf to thigh level) has been confirmed for the state of rest only (lying and standing).The existence of a pressure gradient directed from intramuscular to superficial veins or vice versa has been confirmed for the artificial exercise tests only (tiptoe movements, walking in place etc.).The main calf muscle pump function was considered as its ability to eject blood centripetally by posterior calf muscle group contraction.What New Information Does This Article Contribute?An absence of pressure gradient directed from the calf to the thigh (centripetal) in the great the saphenous vein during locomotion.During locomotion, at the lower leg level, the primary route of blood outflow from the superficial veinous network toward intramuscular veins is a horizontal route (through perforating veins).New parameters are introduced to assess calf muscle pump effectiveness as its ability to maintain accordance between the muscle pump output and arterial blood supply during locomotion.The calf muscle pump (CMP) is known as a significant contributor to venous blood outflow from the lower extremity due to its ability to effectively eject blood in a centripetal direction. Therefore, CMP failure refers to an impaired ejecting ability associated with chronic venous insufficiency (CVI) occurrence and progression. It is expressed in the increase in ambulatory venous pressure referred to as ambulatory venous hypertension (AVH). However, multiple studies demonstrated a lack of agreement between defined CMP failure and AVH, the severity of CVI, and quality of life.Here we show that during locomotion, the CMP acts as a stream diversion pump redirecting blood flow from superficial veins (SVs) to intramuscular veins (IVs) through perforating veins. This is because the observed pressure gradient prevents centripetal blood flow from the calf to thigh level in the SVs and favors blood flow from SVs to IVs during the swing phase of the stride cycle. This function is provided by the synergetic work of antagonist calf muscles (anterior tibial muscle and gastrocnemius). Thereby, the CMP prevents pressure growth in the superficial veins of the lower leg (AVH) during exercise when the arterial blood supply increases according to exercise intensity.

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Section: Introductionmentioning

confidence: 99%

Human lower leg muscle pump acts like a stream diversion pump during locomotion

Tauraginskii,

Lurie,

Simakov

et al. 2023

Preprint

View full text Add to dashboard Cite

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“…There is still an ambiguity among surgeons regarding the treatment of VV. Various modalities of treatments are available, ranging from conservative therapy to surgery [1,2]. Compression stockings, foam sclerotherapy, radiofrequency ablation, and endovenous laser therapy are available for managing VV [3][4][5][6][7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Effect of Trendelenburg’s Operation With Subfascial Ligation of Perforators in Clinical Improvement and Quality of Life Among Patients With Varicose Veins

Vemulakonda¹,

Kumbhar²,

Prakash³

et al. 2023

Cureus

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BackgroundAssessing patients' quality of life has received increasing attention, mainly because questions have been raised regarding the direct benefits of the treatment provided. Hence, clinical outcomes and quality of life must be measured after chronic venous disease treatment. The primary objective of the study was to assess the improvement in clinical outcome and improvement in quality of life using the revised venous clinical severity score and chronic venous insufficiency questionnaire-14, respectively, in patients with varicose veins undergoing Trendelenburg's surgery and subfascial ligation of perforators. The secondary objective was to identify the relationship between the revised venous clinical severity score and the chronic venous insufficiency questionnaire-14 score. MethodThe present study is a single-center, prospective cohort study to assess the clinical improvement and quality of life in patients with varicose veins undergoing Trendelenburg surgery and subfascial ligation of perforators. All the study participants were evaluated preoperatively with the clinical, etiological, anatomical, and pathophysiological stage of the disease, revised venous clinical severity score for the clinical severity, and the chronic venous insufficiency questionnaire-14 questionnaire for the quality of life. The study participants were reviewed 90 days after surgery and reassessed for clinical severity and quality of life, both scores.

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Effect of Elastic Taping Applications of Calf Muscle Pump on the Venous Reflux in patients with Chronic Venous Insufficiency

Kusumawardani,

Andriati,

Tinduh

et al. 2024

RJPT

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Persistent venous hypertension is a pathological condition occurring in chronic venous insufficiency (CVI), as a consequence of venous reflux and/or obstruction and calf muscle pump function failure. The main non-invasive treatment options for improving venous functions and hemodynamics are compression and rehabilitation program of physical activities and modalities. Elastic taping (ET) is one of therapy modality aimed to assist muscle function, increasing lymphatic and vascular flow, correction of joint problems and activation of sensory system. The objective of this study was to assess the eff1ect of ET applications of lateral gastrocnemius (LG), medial gastrocnemius (MG) and tibialis anterior (TA) muscles on it muscles activities and venous reflux after 4 days of application. This is a matched control pre-post study with consecutive sampling. A twenty lower limbs from 10 women with bilateral mild CVI were randomized into control and intervention group. The subjects of each group underwent initial and 4 days after intervention measurement of maximal amplitude of GL, GM, and TA muscles during active contraction and ambulation using surface electromyography (sEMG). Venous reflux of femoral (FV) and popliteal (PV) veins were evaluate using duplex ultrasonography. This study was analyzed with Wilcoxon signed ranks test and Mann-Whitney test. Significant increase of maximal amplitude of the GL and TA muscles during active contraction, also GM muscle during ambulation after 4 days of ET application within intervention group. Significant decrease in the duration of PV reflux after 4 days of ET application within intervention group. Significant difference in the duration of PV reflux when compared to the control group. The conclusions are ET applications of the calf muscle pump system in patient with mild CVI may have an effect of increased muscle activity during active contractions and ambulation expressed as maximum amplitude in sEMG, and also decrease the duration of PV reflux.

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Physical exercise for the treatment of non-ulcerated chronic venous insufficiency

Cited by 3 publications

References 55 publications

Human lower leg muscle pump acts like a stream diversion pump during locomotion

Human lower leg muscle pump acts like a stream diversion pump during locomotion

Effect of Trendelenburg’s Operation With Subfascial Ligation of Perforators in Clinical Improvement and Quality of Life Among Patients With Varicose Veins

Effect of Elastic Taping Applications of Calf Muscle Pump on the Venous Reflux in patients with Chronic Venous Insufficiency

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