Venous reflux has a limited effect on calf muscle pump dysfunction in post-thrombotic patients

Abstract

The purpose of the present study was to evaluate the relationship between calf muscle pump dysfunction (CMD) and the presence and location of valvular incompetence. Deep vein obstruction might influence CMD, and so venous outflow resistance (VOR) was measured. VOR and calf muscle pump function were measured in 81 patients, 7-13 years after venographically confirmed lower-extremity deep venous thrombosis. The supine venous pump function test (SVPT) measures CMD, and the VOR measures the presence of venous outflow obstructions, both with the use of strain-gauge plethysmography. Valvular incompetence was measured using duplex scanning in 16 vein segments of one leg. Venous reflux was measured in proximal veins using the Valsalva manoeuvre, and in the distal veins by distal manual compression with sudden release. Abnormal proximal venous reflux was defined as a reflux time of more than 1 s, and abnormal distal venous reflux as a reflux time of more than 0.5 s. No statistically significant relationship was found between the SVPT and either the location or the number of vein segments with reflux. Of the 81 patients, only nine still had an abnormally high VOR, and this VOR showed no relationship with the SVPT. In conclusion, venous reflux has a limited effect on CMD, as measured by the SVPT. The presence of a venous outflow obstruction did not significantly influence the SVPT. Duplex scanning and the SVPT are independent complementary tests for evaluating chronic venous insufficiency.

A follow-up study of the fate of small asymptomatic deep venous thromboses

“…We found no significant relation between plethysmographic measures of reflux (T 1/2) and presence of reflux demonstrated with CDU. Similar observations are earlier described using another type of plethysmographic evaluation [22]. This lack of relationship probably reflects a combination of the fact that CDU also detects "normal reflux" in some individuals that have no relation to earlier DVT, occurrence of postthrombotic reflux without hemodynamic importance, and the rather high variability of these measurements obtained during exercise [23].…”

Calf muscle pump impairment and delayed healing of venous leg ulcers: Air plethysmographic findings

“…plethysmographic) assessment. Though the majority of patients do not require full evaluation, complicated cases with profound disability often require extensive assessment, also by means of functional testing 6,7,9–14 . It should be emphasized that CVI should not be regarded as a simple pathology of blood vessels, but rather it is a complex syndrome including not only pathological venous circulation but also lymphatic failure, skin changes, and improper functioning of muscles and skeleton of a low extremity.…”

“…Our protocol was similar to that described by Haenen et al. 's supine venous pump function test performed with strain gauge plethysmography 7,8 . Venous reflux and features of obstruction were also assessed (data not shown).…”