Valsalva maneuver in phlebologic practice

Abstract

Forced expiration against an airway obstruction was originally described as a method for inflating the Eustachian tubes and is accredited to Antonio Maria Valsalva (1666-1723). The Valsalva maneuver is commonly applied for different diagnostic purposes. Its use for phlebologic diagnosis is the object this review. Venous reflux is the most frequent pathophysiologic mechanism in chronic venous disease. Reflux is easily visualized by duplex ultrasound when properly elicited, in standing position. A simple way to elicit reflux is the so-called "compression-release maneuver": by emptying the muscle reservoir, it determines a centrifugal gradient, dependent on hydrostatic pressure, creating an aspiration system from the superficial to the deep system. The same results are obtained with dynamics tests activating calf muscles. The Valsalva maneuver elicits reflux by a different mechanism, increasing the downstream pressure and, thus, highlighting any connection between the source of reflux and the refluxing vessel. The Valsalva maneuver is typically used to investigate the saphenofemoral junction. When the maneuver is performed correctly, it is very useful to analyse several conditions and different hemodynamic behaviours of the valvular system at the saphenofemoral junction. Negative Valsalva maneuver always indicates valvular competence at the saphenofemoral junction. Reverse flow lasting during the whole strain (positive Valsalva maneuver) indicates incompetence or absence of proximal valves. Coupling Valsalva maneuver to compression-release maneuver, with the sample volume in different saphenofemoral junction sections, may reveal different hemodynamic situations at the saphenofemoral junction, which can be analysed in detail.

Dual effect of the Valsalva maneuver on autonomic nervous system activity, intraocular pressure, Schlemm’s canal, and iridocorneal angle morphology

“…The VM, is widely used to examine autonomic nervous system function, and is divided into 4 physiological phases [3,7] a lower LF is generally considered to be the combined sympathetic and parasympathetic influence, although this remains controversial [14,15]. An increasing LF/HF represents a predominant sympathetic activation [19].…”

A Current View on the Problem of Varicose Veins of the Pelvis (Review)

“…This method helps to establish presence of varicose veins in the small pelvis by measuring the diameters, blood flow rate in the veins, and to determine preliminarily the leading pathogenetic mechanism: incompetence of the ovarian veins or venous obstruction. This method can also be used for dynamic assessment of conservative and surgical treatment of VVP [22,38,40,[67][68][69][70][71][72][73].…”

“…They are located along the anterior abdominal wall and abdominal rectus muscle slightly lateral to the iliac veins and arteries [78]. The diameter over 5 mm and presence of retrograde blood flow are considered the sign of ovarian vein incompetence at USAS [2,51,69]. USAS of the veins of low extremities, perineum, vulva, inner femoral surface, and buttocks area is mandatory for the adequate examination, prevention of recurrences, and correct treatment tactics.…”

Dual effect of the Valsalva maneuver on autonomic nervous system activity, intraocular pressure, Schlemm’s canal, and iridocorneal angle morphology

“…In phase 4, the impediment to venous return to the heart is removed, and blood is ejected into the constricted vasculature by the heart, causing a pressure overshoot. Finally, parasympathetic activity is reflexively increased, resulting in a relatively quick slowing down of the heart [5][6][7][8].…”

“…The VM is commonly performed during daily life, and is also a diagnostic technique in clinical practice [1,7]. Elevation and fluctuation of IOP are associated with development and progression of glaucoma [16].…”