Pulsatile lower limb venous Doppler flow: prevalence and value in cardiac disease diagnosis.

Abstract

The purpose of this study was to assess the frequency and significance of pulsatile Doppler waveforms in lower limb veins. We used Doppler sonographic data from the common femoral vein. In the first of two groups, the findings in 250 patients were correlated with the presence of cardiac decompensation on concurrent chest radiographs. In the second group, the findings in 81 patients were correlated with the presence of tricuspid regurgitation on Doppler echocardiograms. A venous Doppler sonographic examination was considered normal if spontaneous anterograde phasic flow was present and pulsatile if flow had a cyclic retrograde component. In group 1, 21% had pulsatile waveforms whereas 24% had cardiac decompensation. In group 2, 36% had pulsatile waveforms and 43% had tricuspid regurgitation. A statistically significant correlation was found between the presence of these abnormal waveforms and cardiac decompensation or tricuspid regurgitation, with sensitivities of 57% and 54%, specificities of 91% and 78%, positive predictive values of 66% and 66%, negative predictive values of 87% and 69%, and accuracies of 82% and 68%, respectively. In a subgroup of 55 patients who had both tests for correlation and in whom both were in agreement, the sensitivity of venous Doppler sonographic examination for detecting pathologic cardiac conditions was 79%, specificity was 87%, positive predictive value was 83%, negative predictive value was 84%, and accuracy was 84%. In 77 patients with pulsatile waveforms, including 24 without concurrent chest radiographs or echocardiograms, 63 (82%) had no prior history of cardiac disease. When correlated separately with chest radiograph or Doppler echocardiography, the test is not very sensitive in the diagnosis of cardiac disease; however, when both correlating tests are performed and are in agreement, all diagnostic parameters of the venous Doppler sonographic test, including sensitivity, become fairly high. The presence of pulsatile lower limb venous Doppler flow should alert the sonologist that a pathologic cardiac condition may be the culprit, especially in patients who have no such prior diagnosis.

Pulsatile high-velocity turbulent flow in lower extremity venous ultrasonography

“…Previous studies have reported reverse pulsatile flow in lower extremity veins, which has been attributed to diseases characterised by right atrial pressure elevation 2 3. In the present case, reverse pulsatile flow caused by right atrial pressure elevation secondary to right-sided heart failure was transmitted to the femoral vein, striking the venous valve in retrograde fashion, and creating turbulent jet flow.…”

Correlation of right atrial pressure and blood flow velocities in the common femoral vein obtained by duplex Doppler sonography

“…In that study, the sensitivity of venous Doppler sonography for detecting cardiac abnormalities was 79%, the specificity was 87%, and the accuracy was 84%. 3 Abu-Yousef et al 1 reported that the sensitivity of lower-limb venous Doppler imaging for detecting right-sided heart failure as determined by right atrial pressure measurements was 46%, the specificity was 94%, the negative predictive value was 50%, and the accuracy was 65%. The authors noted that pulsatile lower-limb venous Doppler waveforms corre- late well with right-sided heart failure, as indicated by a right atrial pressure measurement above 8 mm Hg.…”

“…1 In these previous studies, pulsatility of the waveforms was not quantified. 1,3 Cardiac phasicity in lower-limb venous Doppler tracings, however, does not necessarily indicate cardiac disease. Minimal cyclic retrograde flow that is 5 cm/second or less can be observed in Doppler tracings of the CFV in healthy subjects.…”

“…In patients with rightsided cardiac dysfunction, the venous flow pattern in the patient's lower extemities tends to be pulsatile. [1][2][3] Abu-Yousef et al 1 found a significant correlation between increased right atrial pressure and pulsatile venous flow in the lower limbs. The visceral venous system also experiences flow variations caused by fluctuating right atrial pressure.…”

Correlation of central venous pressure with Doppler waveform of the common femoral veins.

“…The right CFV was the only one studied since it is quite close to the heart and is less affected by DVT, [8][9][10] and, if distal thrombosis exists, it does not affect the waveform. 11 The venous wave spectrum was obtained by adequately angling the ultrasound probe (less than 60 degrees). The wall filter was the lowest possible level, and the PRF was adjusted manually to the lowest level to avoid aliasing.…”