Plethysmographic Measurement of Venous Flow Resistance and Venous Capacity in Human Legs. Part Two: Normal Values Related to Age, Sex and Site of Measurement

Objective The purpose of this randomized study was to evaluate the influence of immediate multilayer compression bandages before application of elastic stockings in the acute phase of deep-vein thrombosis (DVT) on development of the post-thrombotic syndrome (PTS). Methods Sixty-nine patients with acute symptomatic DVT were randomized to immediate bandaging (n = 34) or no bandaging (n = 35). After reduction of edema sized-to-fit elastic stockings were applied in all patients after 7-14 days. Follow-up visits and non-invasive examinations were planned after 7, 30 and 90 days and 1 year. Venous outflow resistance (VOR) was measured by strain gauge plethysmography. Thrombosis score (TS) and reflux were measured by duplex scanning. After one year patients were evaluated for clinical PTS using both the clinical scale of the CEAP classification and the Villalta score. Results Improvement of clinical symptoms and decrease of leg circumference was better on day 7 in the bandaging group, but after 1 and 3 months clinical symptoms had improved equally in both groups. In 7 patients in the no-bandaging group a bandage was applied after all because of persistent edema after 10 days. There were no differences in VOR, TS and reflux. Using the CEAP classification the incidence of PTS was 39% in patients with bandages and 42% in patients without bandages (RR 0.91,. Using the Villalta score the incidence of PTS was resp. 29 and 33% (RR 0.87, 95% CI 0.41-1.8). There was no difference in severity of PTS. Conclusion Immediate multilayer compression bandaging in the acute phase of DVT is effective in reducing edema and complaints in the first week, but has no effect on thrombus regression, valve incompetence and the development of clinical PTS after 1 year.

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“…The nonthrombotic leg was always normal and used as control. The reproducibility of the VOR was within 10% [10].…”

Section: Methodsmentioning

confidence: 71%

“…The VOR was measured in both extremities by straingauge plethysmography as described previously [9,10]. In summary the patients were examined in supine position with pneumatic cuffs around the thighs and strain gauges around the calves.…”

Section: Methodsmentioning

confidence: 99%

Multilayer compression bandaging in the acute phase of deep-vein thrombosis has no effect on the development of the post-thrombotic syndrome

Roumen-Klappe

Heijer

Rossum

et al. 2008

J Thromb Thrombolysis

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“…The VOR value is expressed in resistance units: (mmHg x min)/%. In a previous study normal values were determined at <0.80 resistance units [25].…”

Section: Vascular Testingmentioning

confidence: 99%

Clinical and Haemodynamic Sequelae of Deep Venous Thrombosis: Retrospective Evaluation after 7–13 Years

et al. 1997

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1. In contrast to the extensive documentation on diagnosis and treatment of deep venous thrombosis (DVT), information about long-term complications, like the post-thrombotic syndrome (PTS), is scarce. Most studies report on clinical examination only, whereas adequate haemodynamic investigation is lacking. Therefore 81 patients with venographically confirmed lower extremity DVT were clinically and haemodynamically reexamined 7-13 years after DVT (mean 10 years) to assess PTS. Interest was focused on the relation between clinical and haemodynamic PTS and the relation between location of the initial DVT and incidence of PTS. 2. Clinical signs and symptoms of PTS were classified according to the latest consensus of the international consensus committee on chronic venous disease. Non-invasive venous vascular laboratory tests were performed to assess the venous outflow resistance and calf muscle pump function (CMP). CMP was determined by the supine venous pump function test (SVPT). 3. Clinically only 20 of 81 patients (25%) were asymptomatic, 34 (42%) had mild PTS (class 1-3), 25 (31%) moderate PTS (class 4) and 2 (2%) severe PTS (class 5-6); 57% had an abnormal CMP. Both the severity of clinical symptoms and the haemodynamic abnormalities were related to the location of the initial thrombus. Of the patients with distal DVT 11% developed moderate clinical PTS and 39% developed an abnormal CMP. CMP and difference in CMP between post-thrombotic and non-thrombotic leg were significantly related to the different classes of PTS. 4. This study indicates that 7-13 years after DVT 31% of the patients had moderate and 2% had severe clinical PTS, while 57% of the patients had abnormal haemodynamic findings (both related to the initial site of the thrombosis). Secondly, it reveals that the risk of PTS after distal DVT is not negligible, which causes concern about not diagnosing and treating patients with distal DVT. Thirdly, we have demonstrated that a functional test, such as the SVPT, is a sensitive test to assess post-thrombotic damage. Therefore its use as a screening tool after a period of DVT should be investigated to select patients at risk of PTS.

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“…From the venous emptying rates at different pressures, the VOR of the leg was determined. A VOR exceeding 0.8 mmHg min/% was regarded as abnormal 21 .…”

Section: Methodsmentioning

confidence: 99%

A three-parameter model for the venous pressure volume relation of the lower leg

Langen¹

2003

Phlebology

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The venous system has a low blood pressure compared with the arterial system. The pulsatile nature of the blood pressure in the arterial system is absent in the venous system. These functional disparities, in combination with differences in the composition of the vessel wall, account for the observations that the venous system has distinctly different visco-elastic properties compared with those of the arterial system 1 . The visco-elastic properties of the arterial tree have been the subject of many studies and a relationship between these properties and the early onset of atherosclerosis has been established 2-5 . Sparse information is available about the potential relationship between the visco-elastic properties of the venous system and venous diseases.Deep venous thrombosis (DVT) and chronic venous insufficiency (CVI) are the most common venous diseases of the lower leg. A significant number of DVT patients will develop complications of the venous system of the lower leg 6 -9 . The developmental process of venous complications is not completely understood. Longlasting elevated venous pressure resulting from venous valve insufficiency is considered the primary cause of lower leg venous abnormality 1 0 . A continuous elevated venous pressure will alter the microcirculation and eventually lead to tissue necrosis and ulceration 11,12 .A relation called the venous pressure volume relation (VPVR) relates the venous pressure in the leg to the venous volume of the leg. The VPVR carries information about visco-elastic properties of the venous system. AbstractObjectives: To derive a three-parameter model for the curvilinear venous pressure volume relation of the lower leg, and to test its consistency. Methods: A model with venous pressure at rest (P 0 , mmHg), the venous compliance at P 0 (C 0 , %/mmHg) and the venous stiffness constant (k, 1/%) was derived. With strain gauge plethysmography the venous pressure volume relations of both legs at the mid-calf and at the ankle region were measured and fitted in 120 consecutive patients in the supine position. Results: No difference was observed between the mid-calf P 0 (right 8.1 ± 2.2, left 8.4 ± 2.1) nor between ankle P 0 (right 10.1 ± 2.3, left 10.0 ± 2.1). A significant pressure difference of -1.8 mmHg was found between mid-calf and ankle. Leg side differences were not observed for either C 0 at the ankle (right 0.36 ± 0.29, left 0.49 ± 0.85) or in the mid-calf region (right 0.54 ± 1.1, left 0.46 ± 1.0). Differences for the leg region but not for the leg side were found for k (mid-calf right 0.54 ± 0.38, left 0.64 ± 0.52, ankle right 1.32 ± 0.66 and left 1.33 ± 0.65). Conclusion: The model demonstrated provided a proper description of the curvilinear venous pressure volume relation.

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Plethysmographic Measurement of Venous Flow Resistance and Venous Capacity in Human Legs. Part Two: Normal Values Related to Age, Sex and Site of Measurement

Cited by 13 publications

References 6 publications

Multilayer compression bandaging in the acute phase of deep-vein thrombosis has no effect on the development of the post-thrombotic syndrome

Multilayer compression bandaging in the acute phase of deep-vein thrombosis has no effect on the development of the post-thrombotic syndrome

Clinical and Haemodynamic Sequelae of Deep Venous Thrombosis: Retrospective Evaluation after 7–13 Years

A three-parameter model for the venous pressure volume relation of the lower leg

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