Venous pressure gradients in the lower extremity and the hemodynamic consequences

VASA ◽  
2010 ◽  
Vol 39 (4) ◽  
pp. 292-297 ◽  
Author(s):  
Recek
Keyword(s):  
Saphenous Vein ◽  
Pressure Difference ◽  
Great Saphenous Vein ◽  
Varicose Veins ◽  
Femoral Vein ◽  
Venous Pressure ◽  
Lower Leg ◽  
High Ligation ◽  
Venous Reflux ◽  
Pump Activity

Pressure differences play an important role in the hemodynamics of both arterial and venous circulation. Venous ambulatory pressure gradient of about 35 mm Hg arises during the activity of the calf muscle venous pump between the veins in the thigh and the lower leg; this is the initiator launching venous reflux in varicose vein patients. The hemodynamic consequence of venous reflux is interference with the physiological decrease in venous pressure in the lower leg and foot and the occurrence of ambulatory venous hypertension, the degree of which depends on the magnitude of refluxing blood. Pressure difference occurring between the femoral vein and the remnant of great saphenous vein after high ligation or crossectomy during calf pump activity may be the activator of the process leading to the building of new venous communicating channels, the consequence of which is recurrent reflux. Neovascularization is apparently triggered by this hemodynamic factor, not by the surgical procedure itself, because neovascularization does not occur after harvesting of the great saphenous vein in the groin in people without varicose veins. Venous pressure potentials developing in the lower leg during the calf pump activity force the blood to flow from deep into superficial veins during muscle contraction and in the opposite direction during muscle relaxation. An untoward event caused by venous pressure difference is presented - spontaneous bypassing of a competent valve in the saphenous remnant after crossectomy, which converted a favourable hemodynamic situation into a harmful one. Possible explanation of this undesirable event is offered.

Invasive therapeutic options in truncal varicosity of the great saphenous vein

VASA ◽  
2006 ◽  
Vol 35 (3) ◽  
pp. 157-166 ◽  
Author(s):  
Hach-Wunderle ◽  
Hach
Keyword(s):  
Minimally Invasive ◽  
Saphenous Vein ◽  
Venous Insufficiency ◽  
Great Saphenous Vein ◽  
Varicose Veins ◽  
Venous Pressure ◽  
Stage Iii ◽  
High Ligation ◽  
Surgical Trauma ◽  
Disease Stages

It is known from current pathophysiology that disease stages I and II of truncal varicosity of the great saphenous vein do not cause changes in venous pressure on dynamic phlebodynamometry. This is possibly also the case for mild cases of the disease in stage III. In pronounced cases of stage III and all cases of stage IV, however, venous hypertension occurs which triggers the symptoms of secondary deep venous insufficiency and all the complications of chronic venous insufficiency. From these facts the therapeutic consequence is inferred that in stages I and II and perhaps also in very mild cases of stage III disease, it is enough "merely" to remove varicose veins without expecting there to be any other serious complications in the patient’s further life caused by the varicosity. Recurrence rates are not included in this analysis. In marked cases of disease stages III and IV of the great saphenous vein, however, secondary deep venous insufficiency is to be expected sooner or later. The classical operation with saphenofemoral high ligation ("crossectomy") and stripping strictly adheres to the recognized pathophysiologic principles. It also takes into account in the greatest detail aspects of minimally invasive surgery and esthetics. In the past few years, developments have been advanced to further minimize surgical trauma and to replace the stripping maneuver using occlusion of the trunk vein which is left in place. Obliteration of the vessel is subsequently performed via transmission of energy through an inserted catheter. This includes the techniques of radiofrequency ablation and endovenous laser treatment. High ligation is not performed as a matter of principle. In a similar way, sclerotherapy using microfoam is minimally invasive in character. All these procedures may be indicated for disease stages I and II, and with reservations also in mild forms of stage III disease. Perhaps high ligation previously constituted overtreatment in some cases. Targeted studies are still needed to prove whether secondary deep venous insufficiency can be avoided in advanced stages of varicose vein disease without high ligation and thus without exclusion of the whole recirculation circuit.

Femoral vein valve incompetence as a risk factor for junctional recurrence

2017 ◽  
Vol 33 (3) ◽  
pp. 206-212 ◽  
Author(s):  
Sergio Gianesini ◽  
Savino Occhionorelli ◽  
Erica Menegatti ◽  
Anna Maria Malagoni ◽  
Mirko Tessari ◽  
...  
Keyword(s):  
Risk Factor ◽  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
Varicose Veins ◽  
Femoral Vein ◽  
Recurrence Risk ◽  
High Ligation ◽  
Frequent Event ◽  
Operative Assessment ◽  
Reflux Recurrence

Background Recurrent varicose veins occur up to 80% of procedures. The sapheno-femoral junction can be involved in more than 50% of cases. A detailed pathophysiological explanation of the phenomenon is still missing. The aim of the present work is to evaluate the role of femoral vein incompetence as risk factor for sapheno-femoral junction recurrence. Methods Three-hundred-eighty-one patients presenting an incompetent great saphenous vein system and eventually also an incompetent femoral tract (C2-6EpAsdPr) underwent a great saphenous vein high ligation with flush ligation also of the incompetent tributaries along the leg, sparing the saphenous trunk. Pre-operatively, all patients underwent a sonographic evaluation assessing the superficial and deep venous systems, including a detailed analysis of the iliac-femoral vein tract above the sapheno-femoral junction. A retrospective statistical analysis assessed the recurrence risk associated with iliac-femoral vein tract incompetence. Results In a 5.5 ± 1.9 years follow-up, great saphenous vein trunk reflux recurrence was detected in 45/381 (11.8%) cases. The reflux source was found in a reconnected sapheno-femoral stump in 11/45 cases (24.5%), in the pelvic network in 8/45 cases (17.8%), in a neovascularization process in 7/45 (15.5%) and in a newly incompetent great saphenous vein tributary in 19/45 (42.2%). At the pre-operative assessment, iliac-femoral vein tract reflux was present in 7 (26.9%) of the 26 cases who developed a sapheno-femoral junction recurrence and in 25 (7%) of the 355 patients who did not demonstrate sapheno-femoral junction recurrence (odds ratio: 4.8; confidence interval 95%: 1.8–12.6; p < .003). Discussion Despite many technical diagnostic and therapeutic refinements, varicose veins recurrence remains a frequent event. The present investigation points out the association among iliac-femoral vein tract incompetence and sapheno-femoral junction recurrences after high ligation.

Druckgradient in den Beinvenen während der Betätigung der Wadenpumpe

VASA ◽  
2000 ◽  
Vol 29 (3) ◽  
pp. 187-190 ◽  
Author(s):  
Cestmir Recek ◽  
Pojer
Keyword(s):  
Saphenous Vein ◽  
Varicose Veins ◽  
Femoral Vein ◽  
Venous Pressure ◽  
Standing Position ◽  
Quiet Standing ◽  
High Ligation ◽  
Long Saphenous Vein ◽  
Primary Varicose Veins ◽  
Reflux Recurrence

Background: Neovascularization is an important cause of venous reflux recurrence after high ligation of the long saphenous vein. The pathogenesis of this phenomenon is so far obscure. It is possible that a hemodynamic factor – a pressure gradient between the femoral vein and the residual long saphenous vein – could be the trigger initiating the process of neovascularization. Patients and methods: Venous pressure measurements on eight patients with primary varicose veins were performed in the erect position in the insufficient long saphenous vein on the thigh. Mean pressures in the quiet standing position and ambulatory pressures were considered. By interrupting the saphenous reflux either distally or proximally to the point of measurement the pressure conditions either in the femoral or in the crural veins were simulated. Results: With the tourniquet placed distally to the point of measurement, the venous pressure in the upper interrupted segment of the long saphenous vein (equivalent to the pressure in the femoral vein) remained uninfluenced during ambulation. In contrast, by interrupting the reflux proximally to the point of measurement, a marked decrease of the ambulatory pressure in the lower part of the long saphenous vein (equivalent to the pressure in the crural veins) was noted. Conclusions: A pressure difference occurs between the veins of the thigh and the lower leg during the activation of the muscle venous pump. This fact may explain the tendency of recurrencies of varicose veins after high ligation of the long saphenous vein as well as the initiation of reflux.

scholarly journals The hemodynamic impact of the bidirectional flow within calf perforators and conductive veins in varicose vein disease

2020 ◽  
Vol 5 (3) ◽  
Author(s):  
Cestmir Recek ◽  
Keyword(s):  
Saphenous Vein ◽  
Varicose Vein ◽  
Great Saphenous Vein ◽  
Diastolic Pressure ◽  
Venous Pressure ◽  
Lower Leg ◽  
Hemodynamic Assessment ◽  
Pump Activity ◽  
Bidirectional Flow ◽  
Vein Disease

The hemodynamic assessment of the bidirectional flow within calf perforators and in the conductive veins in varicose vein disease is presented. The bidirectional streaming within calf perforators is induced by the changing polarity of the systolic and diastolic pressure gradients arising during calf pump activity between the deep veins and the saphenous system of the lower leg, as documented by simultaneous pressure measurements in the posterior tibial vein and the great saphenous vein. This bidirectional flow makes the deep and superficial veins of the lower leg conjoined vessels. The vector of the bidirectional streaming in varicose vein patients is oriented inward, into the deep veins. The enlarged calf perforators are the consequence of the saphenous reflux; after elimination of saphenous reflux the diameter of calf perforators diminishes significantly. Results of venous pressure, plethysmographic and electromagnetic flow measurements rebut the still prevalent opinion that the outward flow within calf perforators is a reflux. There is an up-and-down flow in the conductive veins during calf pump activity with a prevailing systolic centripetal (orthograde) flow in the popliteal/femoral axis and a diastolic centrifugal (retrograde) flow in the incompetent great saphenous vein. The popliteal vein represents actually the drain pipe of the calf muscle pump. The ambulatory venous pressure gradient arising during the diastolic phase of the calf pump activity resembles the diastolic pressure difference between the aorta and the left ventricle.

scholarly journals VENOUS HEMODYNAMICS IN ACUTE VARICOTHROMBOPHLEBITIS IN THE GREAT SAPHENOUS VEIN BASIN

2021 ◽  
pp. 69-74
Author(s):  
S. S. Filip ◽  
V. V. Rusyn ◽  
І. І. Hadzheha
Keyword(s):  
Blood Flow ◽  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
Varicose Veins ◽  
Femoral Vein ◽  
Venous Blood ◽  
The State ◽  
Venous System ◽  
Venous Blood Flow ◽  
Venous Reflux

Abstract. Objective. To evaluate the influence of venous hemodynamics in acute varicothrombophlebitis in the basin of the great saphenous vein on the spread of the thrombotic process. Materials and methods. The analysis of venous hemodynamic disorders in 245 patients with acute varicothrombophlebitis in the basin of the great saphenous vein was performed. The age of patients participating in the study ranged from 19 to 82 years (mean age 52±2,7 years). There were 93 men (38.0%) and 152 women (62.0%). The laboratory and instrumental methods were used for all the patients. They included doppler ultrasound and ultrasound duplex scanning. («ULTIMA PRO–30, zone Ultra», ZONARE Medical Systems Inc., USA). Results. When AVTF occurred in the GSV basin, all patients showed reflux in the superficial veins of the lower extremities. The ultrasound scanning was performed at the initial examination and immediately before urgent surgery for AVTF. The data of color duplex mapping allowed to reveal certain regularities of venous blood flow disturbance in AVTF and divided patients depending on the state of venous blood flow in the GSV basin into 5 groups. Each of these groups of patients, depending on the prevalence of venous reflux in the GSV pool, was divided into two subgroups: local and widespread reflux. It should be noted, that the conditions for the detection of total reflux in ATVF, with the involvement of GSV in the pathological process, were not due to thrombotic lesions of the latter. When venous reflux was detected, the elasticity and extensibility of the vein wall at the apex of thrombotic masses were evaluated. The ratio of the diameters of the GSV in these positions and the assessment of the "degree of elasticity" by Schwalb PG (2005), which indirectly characterized the state of venous tone were calculated. Venous reflux was assessed on a Valsalva test in vertical and horizontal positions. Venous reflux of blood in the femoral veins was found in 134 (54.7%) patients. At the same time, local reflux was found in 38 (15.5%), and widespread - in 96 (39.2%) patients. It should be noted that the prevalence of venous reflux was directly proportional to its power. Among all groups of patients with acute varicothrombophlebitis, 176 (71.8%) had widespread reflux in the great saphenous vein and 96 (39.2%) in the femoral vein. In 37 (15.1%) patients with acute varicothrombophlebitis revealed a combined nature of reflux, ie the spread of reflux from the superficial venous system not only to the apex of thrombotic masses, but also to the site of horizontal perforation, and reflux from the deep venous system spread through failed perineal veins in the great saphenous vein. Thus, widespread venous reflux was found in 87.3% of patients. In the absence of vertical reflux through the sapheno-femoral cochlea and the presence of an ascending process of thrombosis, it is necessary to identify another source of reflux. Conclusions. It is proved that the process of thrombosis in acute varicothrombophlebitis depends on the power of venous reflux, the severity of venous discharge through the communicating veins, the state of collateral venous blood flow in venous shunts and basins of large and small subcutaneous venous blood vessels. Venous reflux in the trunk of the great saphenous vein to some extent determines the embolism of the thrombus and participates in its development. Varicose veins of the great saphenous vein and the discharge of blood through incapable permeable veins reduce the power of reflux through the sapheno-femoral cochlea and reduce the rate of thrombosis in the main trunk.

Neovascularization in Restoration of Continuity of the Rat Femoral Vein following Surgical Interruption

1987 ◽  
Vol 2 (1) ◽  
pp. 1-5 ◽  
Author(s):  
G.M. Glass
Keyword(s):  
Surgical Treatment ◽  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
Varicose Veins ◽  
Femoral Vein ◽  
Histological Studies ◽  
Venous Circulation ◽  
Main Vein

Recurrence of varicose veins after surgical treatment by ligation and transection has been usually attributed to development of varicosity in veins collateral to the transected vessels. Early studies reported regeneration of the great saphenous vein at the site of previous transection. The present study in the rat was undertaken to determine whether restoration of normal venous circulation in a limb after surgical interruption of the main vein develops through enlargement of collateral veins or by restoration of continuity of the interrupted vein as a result of neovascularization at the site of ligation. Following ligation in continuity or ligation and surgical transection of the rat common iliac or femoral vein, phlebographic, surgical exploratory and histological studies showed restoration of its continuity through newly formed vessels. These findings suggest that in recurrence of varicose veins the roles of neovascularization and of collateral veins deserve further investigation.

Plication of the Sapheno–Femoral Junction: Effects on Incompetence after Two Years

1991 ◽  
Vol 6 (3) ◽  
pp. 159-165 ◽  
Author(s):  
Giovanni V. Belcaro
Keyword(s):  
Coronary Artery ◽  
Saphenous Vein ◽  
Femoral Vein ◽  
Venous Pressure ◽  
Signs And Symptoms ◽  
Long Term Results ◽  
Pressure Measurements ◽  
Venous Reflux ◽  
Long Saphenous Vein

Plication of the long saphenous vein at the sapheno–femoral junction (SFJ) is an alternative to flush ligation and stripping. This technique abolishes reflux at the SFJ without altering the vein; this may then be used for arterial surgery or coronary artery grafting. Candidates for plication were selected on the basis of ambulatory venous pressure measurements and duplex scanning. These tests indicate and quantify the degree of superficial venous incompetence. Plication of the SFJ reduces the calibre of the vein to 60–70% for a length of 1.5 cm, allowing the value cusps to close when flow in the femoral vein is reversed. In this study 20 limbs were evaluated (in 20 patients) 6, 12 and 24 months after plication. Venous reflux was significantly reduced and there was an improvement in signs and symptoms. Thus, SFJ plication seems to be an effective physiological alternative to flush ligation in some subjects. However, long-term results (> 5 years) must be still evaluated.

Anatomy of the lymph node venous networks of the groin and their investigation by ultrasonography

2015 ◽  
Vol 31 (5) ◽  
pp. 334-343 ◽  
Author(s):  
Jean Francois Uhl ◽  
Miguel Lo Vuolo ◽  
Nicos Labropoulos
Keyword(s):  
Lymph Node ◽  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
Varicose Veins ◽  
Femoral Vein ◽  
Normal Subjects ◽  
Chronic Venous Disease ◽  
Venous Disease ◽  
Anatomical Dissection ◽  
Anatomical Finding

Objective To describe the anatomy of the lymph node venous networks of the groin and their assessment by ultrasonography. Material and methods Anatomical dissection of 400 limbs in 200 fresh cadavers following latex injection as well as analysis of 100 CT venograms. Routine ultrasound examinations were done in patients with chronic venous disease. Results Lymph node venous networks were found in either normal subjects or chronic venous disease patients with no history of operation. These networks have three main characteristics: they cross the nodes, are connected to the femoral vein by direct perforators, and join the great saphenous vein and/or anterior accessory great saphenous vein. After groin surgery, lymph node venous networks are commonly seen as a dilated and refluxing network with a dystrophic aspect. We found dilated lymph node venous networks in about 15% of the dissected cadavers. Conclusion It is likely that lymph node venous networks represent remodeling and dystrophic changes of a normal pre-existing network rather than neovessels related to angiogenic factors that occur as a result of an inflammatory response to surgery. The so-called neovascularization after surgery could, in a number of cases, actually be the onset of dystrophic lymph node venous networks. Lymph node venous networks are an ever-present anatomical finding in the groin area. Their dilatation as well as the presence of reflux should be ruled out by US examination of the venous system as they represent a contraindication to a groin approach, particularly in recurrent varicose veins after surgery patients. A refluxing lymph node venous network should be treated by echo-guided foam injection.

scholarly journals Saphenous Ladder Formed by Almost Completely Duplicated Great Saphenous Vein

2020 ◽  
Vol 18 (1) ◽  
pp. 99-101
Author(s):  
Vasanthakumar Packiriswamy ◽  
Satheesha B Nayak
Keyword(s):  
Saphenous Vein ◽  
Lower Limb ◽  
Great Saphenous Vein ◽  
Varicose Veins ◽  
Femoral Vein ◽  
Saphenous Veins ◽  
Left Lower Limb ◽  
Male Cadaver ◽  
Complete Duplication ◽  
Femoral Triangle

Knowledge of normal as well as variant great saphenous vein is useful as it is the vein that can get varicosed; the vein that is used in bypass surgeries and the vein that is used for cannulation purpose. We observed almost complete duplication of the great saphenous vein in the left lower limb of an adult male cadaver. Both the great saphenous veins arose from the medial end of the dorsal venous arch and coursed parallel to each other throughout the limb. They united in the femoral triangle to form a short (1 inch long) common great saphenous vein. Common great saphenous vein terminated into the femoral vein. There were four communicating veins connecting the two great saphenous veins in the leg, giving the appearance of a venous ladder. Knowledge of this variation could be extremely useful in treatment of varicose veins of lower limb, in catheterizations and in various surgical procedures of the lower limb.

The condition of the veins of the femoral-iliac segment in patients with varicose veins of the lower extremities

1982 ◽  
Vol 63 (4) ◽  
pp. 63-66
Author(s):  
V. E. Mamaev ◽  
M. F. Musin ◽  
M. N. Malinovsky
Keyword(s):  
Contrast Agent ◽  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
Varicose Veins ◽  
Femoral Vein ◽  
Lower Extremities ◽  
The State ◽  
Contrast Study ◽  
Aneurysmal Dilatation ◽  
Saphenous Veins

In 70 patients with varicose veins of the lower extremities, the state of the venous bed of the femoral-iliac segment was studied by methods of proximal pelvic and retrograde-femoral phlebography. The characteristic radiological signs of varicose veins were found: ectasia of the iliac and femoral veins, failure of the valve of the sapheno-femoral anastomosis with reflux of the contrast agent into the great saphenous vein, aneurysmal dilatation of the mouth of the great saphenous vein, partial or complete insufficiency of the valves of the femoral vein. It was found that in 35.7% of cases, the cause of the development of hypertension and varicose veins of the saphenous veins was segmental narrowing of the veins and compression of the femoral vein in the region of the pupar ligament, various extravasal compression of the main veins of the femoral-iliac segment with bone protrusions, a cross-passing artery, and an enlarged uterus. It is recommended, when studying the venous hemodynamics of the lower extremities, simultaneously with the use of distal phlebography, to carry out a contrast study of the pelvic veins

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