Abnormal venous function in patients with homozygous sickle cell (SS) disease and chronic leg ulcers

2000 ◽  
Vol 98 (6) ◽  
pp. 667-672 ◽  
Author(s):  
Junette S. MOHAN ◽  
Jacqueline E. VIGILANCE ◽  
Janice M. MARSHALL ◽  
Ian R. HAMBLETON ◽  
Harvey L. REID ◽  
...  
Keyword(s):  
Sickle Cell ◽  
Venous Pressure ◽  
Venous Blood ◽  
Venous Occlusion ◽  
Leg Ulcers ◽  
Venous Capacitance ◽  
Doppler Flowmetry ◽  
Venous Valves ◽  
Venous Ulcers ◽  
Venous Function

Chronic leg ulceration is a major cause of morbidity in homozygous sickle cell (SS) disease in Jamaica. These ulcers have features in common with venous ulcers in patients with a normal haemoglobin genotype (AA). Thus we sought to determine whether there is abnormal venous function in the legs of patients with SS disease who have ulcers. Experiments were performed on 15 SS patients with ulcers, and on 15 SS patients and 15 AA subjects with no history of leg ulcers. Changes in venous blood volume of the bottom one-third of the leg induced by venous occlusion and release were studied by air plethysmography, providing indices of segmental venous capacitance (SVC), maximal venous outflow (MVO) and venous emptying time (VET). The changes in volume (ambulatory volume change; AVC) induced by a period of leg exercise were also measured at the ankle (AVCa) and calf (AVCc); venous refilling times at these sites (RTa and RTc respectively) were also measured. Finally, cutaneous red blood cell flux recovery time (FRT) after ankle exercise was assessed by laser Doppler flowmetry. Measurements were also made of haematological variables. SVC, MVO and VET did not differ between the groups, indicating no deep venous obstruction in the SS patients with ulcers. AVCc, AVCa and RTc did not differ among the three subject groups. However, compared with AA subjects, SS patients with ulcers had reduced RTa and FRT. Moreover, RTa and FRT were further shortened in SS patients with ulcers relative to SS patients without ulcers. Since the levels of anaemia were similar in SS patients with and without ulcers, these differences cannot be attributed to differences in arterial flow secondary to anaemia. These results suggest abnormal venous function in SS patients with ulcers, relative to both AA subjects and SS patients without ulcers. We propose that there is incompetence of venous valves draining the ankle region of SS patients with ulcers: the consequent raised venous pressure contributes to the slow healing and, possibly, to the onset of leg ulceration in SS disease.

Microvascular Evaluation by Laser—Dopper Flowmetry of the Effects of Centellase in the Treatment of Severe Venous Hypertension and Leg Ulcers

1987 ◽  
Vol 2 (3) ◽  
pp. 189-195 ◽  
Author(s):  
G. Belcaro
Keyword(s):  
Venous Pressure ◽  
Venous Hypertension ◽  
Leg Ulcers ◽  
Vasomotor Response ◽  
Venous Ulceration ◽  
Doppler Flowmetry ◽  
Before And After ◽  
Venoactive Drugs ◽  
Positive Effect ◽  
Standard Techniques

A study of the microcirculation in patients with venous hyperterision and perimalleolar ulcers was used to evaluate the effects of medical treatment by Centellase 60. The evaluation of the resting flow and the observation of the venous response before and after treatment shows an interesting, positive effect of Centellase 60 in 25 patients with venous ulceration treated for 4 weeks. The decrease of the resting flow and the increased efficacy of the venous vasomotor response was both significant and associated with a significant decrease of the ulcerated areas. Laser-Doppler flowmetry was useful to demonstrate microcirculatory changes which were not revealed by standard techniques such as ambulatory venous pressure. It may be useful to reveal variations in venous hypertension produced by other treatments such as elastic compression or ‘venoactive’ drugs.

The role of venous capacitance, circulating catecholamines, and heart rate in the hemodynamic response to increased temperature and hypoxia in the dogfish

2009 ◽  
Vol 296 (5) ◽  
pp. R1547-R1556 ◽  
Author(s):  
Erik Sandblom ◽  
Georgina K. Cox ◽  
Steve F. Perry ◽  
Anthony P. Farrell
Keyword(s):  
Heart Rate ◽  
Venous Pressure ◽  
Venous Blood ◽  
Severe Hypoxia ◽  
Venous Capacitance ◽  
Venous Circulation ◽  
Passive Flow ◽  
Increased Temperature ◽  
Blood Pressures

Hypoxia and increased temperature alter venous blood pressures in teleosts through active changes in venous tone. Elasmobranchs possess a capacious venous system but have limited adrenergic vascular innervation and subambient central venous pressure (Pcv). In this study, we explored venous hemodynamic responses to acute temperature increase and moderate (6.9 kPa) and severe (2.5 kPa) hypoxia in the dogfish ( Squalus acanthias). Normoxic dogfish at 10°C had a Pcv between −0.08 and −0.04 kPa and a mean circulatory filling pressure (Pmcf) of ∼0.12 kPa. At 16°C, heart rate ( fH), cardiac output (Q), and Pmcf increased but Pcv and plasma epinephrine and norepinephrine levels were unchanged. In contrast, moderate and severe hypoxia increased Pcv and decreased Q and stroke volume (VS). fH decreased in severe hypoxia, whereas Pmcf was unaffected despite elevated catecholamine levels. Atropine abolished hypoxic reductions in Q, VS, and fH, but Pcv still increased. In contrast to the response in teleosts, this study on dogfish suggests that venous capacitance changes associated with warming and hypoxia are minimal and likely not mediated by circulating catecholamines. Thus hemodynamic status of the capacious elasmobranch venous circulation is potentially regulated by blood volume shifts from passive flow-mediated events and possibly through myogenic mechanisms.

Abnormal venous function in patients with homozygous sickle cell (SS) disease and chronic leg ulcers

2000 ◽  
Vol 98 (6) ◽  
pp. 667 ◽  
Author(s):  
Junette S. MOHAN ◽  
Jacqueline E. VIGILANCE ◽  
Janice M. MARSHALL ◽  
Ian R. HAMBLETON ◽  
Harvey L. REID ◽  
...  
Keyword(s):  
Sickle Cell ◽  
Leg Ulcers ◽  
Venous Function ◽  
Chronic Leg Ulcers

Pitfalls of venous occlusion method for determination of capillary pressure in humans

1989 ◽  
Vol 66 (2) ◽  
pp. 997-1002
Author(s):  
B. Braam ◽  
H. A. Koomans ◽  
T. J. Rabelink ◽  
R. Berckmans
Keyword(s):  
Capillary Pressure ◽  
Venous Pressure ◽  
Venous Occlusion ◽  
Upper Arm ◽  
Basic Principles ◽  
Venous Valves ◽  
Large Pressure ◽  
Cubital Fossa ◽  
The One

We tested the method of estimating capillary pressure from venous pressure transients obtained after sudden venous clamping in a hydrodynamic model. The basic principles were confirmed in the model, but it was found that when occlusion was caused over a relatively wide distance or in a predistended vessel, capillary pressure was overrated. This problem was due to volume backflow from the occlusion site, since it could be eliminated by placing a one-way valve upstream from the occlusion site. Upstream from the valve, the venous pressure transient accurately followed capillary pressure. Downstream, however, the reading of capillary pressure was impaired by the backflow volume squeezed between valve and occlusion clamp, which caused an immediate large pressure elevation. We also tested the method recently advanced to estimate capillary pressure in humans from venous pressure curves obtained after rapid venous occlusion with an air-filled compression cuff. With the cuff around the upper arm, venous pressure was recorded at different levels along the forearm. The tracings obtained from the dorsum of the hand and halfway along the forearm did not show the initial rapid upstrokes that might indicate the capillary pressure. Tracings obtained slightly below or above the cubital fossa were similar to those seen downstream from the one-way valve in the model. Extrapolation to zero-time, using the distally recorded curves as a template, yielded values equal to venous pressure. We conclude that although the problem of backflow can be circumvented by pressure recording distal from venous valves, the method of venous occlusion by a circular upper-arm cuff may not be appropriate to estimate capillary pressure in humans.

Videophlebography with Foot Venous Pressure Measurements: Description of a Technique for Diagnosing Venous Dysfunction

1997 ◽  
Vol 12 (3) ◽  
pp. 100-106 ◽  
Author(s):  
O. Björgell ◽  
O. Ekberg ◽  
H. Åkesson ◽  
R. Olsson
Keyword(s):  
Preoperative Evaluation ◽  
Venous Pressure ◽  
Video Recording ◽  
University Hospital ◽  
Pressure Measurements ◽  
Combined Approach ◽  
Venous Anatomy ◽  
Venous Valves ◽  
Venous Function ◽  
Deep Vein

Objective: To introduce phlebography with simultaneous video recording of the fluoroscopy (VIP, videophlebography), to improve phlebography performed in patients with venous dysfunction. Ambulatory foot venous pressure (AVP) was measured in the same session. Design: Descriptive study of an improved phlebographic technique. Setting: University Hospital MAS, Malmö, Sweden. Study group: Forty-one consecutive patients (50 legs) referred to phlebographic investigation. In the last 27 legs the AVP was also measured. Intervention: Phlebography with video recording and measurement of AVP. Results: In 49 out of 50 (98%) of the VIPs, information allowing a detailed description of venous function was obtained. Normal closing of venous valves, seen on the ascending VIP, combined with a normal venous pressure made it possible to exclude deep vein incompetence and avoid descending phlebography. In 16 out of 27 legs (59%) this combined approach showed that descending phlebography was unnecessary. Conclusion: VIP provides an adequate image of the venous anatomy, important in preoperative evaluation. The combination of this technique with AVP may clarify the pathophysiological abnormalities resulting from the venous dysfunction.

Chronische venöse Insuffizienz in einer Minderzahl von Patienten mit Ulcus cruris infolge einer Sichelzellanämie

VASA ◽  
2001 ◽  
Vol 30 (4) ◽  
pp. 277-279 ◽  
Author(s):  
H. Chalchal ◽  
W. Rodino ◽  
S. Hussain ◽  
I. Haq ◽  
I. Panetta ◽  
...  
Keyword(s):  
Sickle Cell ◽  
Sickle Cell Anemia ◽  
Venous Insufficiency ◽  
Duplex Ultrasound ◽  
Ulcus Cruris ◽  
Leg Ulcers ◽  
Venous Reflux ◽  
Venöse Insuffizienz ◽  
Venous Function ◽  
Chronic Leg Ulcers

Background: Chronic or recurrent leg ulceration occurs in 25% of sickle cell anemia patients, but not in the remaining 75%. Doppler studies of venous function were normal in 16 sickle cell anemia patients with leg ulcers. Patients and methods: Venous Duplex Ultrasound was used to study 33 sickle cell anemia patients with chronic leg ulcers. Results: Six of the 33 patients had venous reflux in at least one leg. Conclusions: Venous insufficiency may contribute to the development of leg ulcers in a minority of sickle cell anemia patients. A minority of sickle cell anemia patients with chronic leg ulcers can be shown to have leg venous reflux by duplex ultrasound imaging.

Mechanism of the postural vasoconstrictor response in the human foot

1988 ◽  
Vol 75 (4) ◽  
pp. 379-387 ◽  
Author(s):  
Ahmad A. K. Hassan ◽  
J. E. Tooke
Keyword(s):  
Diastolic Pressure ◽  
Venous Pressure ◽  
Systolic Pressure ◽  
Sympathetic Nerves ◽  
Venous Occlusion ◽  
Central Component ◽  
Small Contribution ◽  
Doppler Flowmetry ◽  
Human Foot ◽  
Local Mechanism

1. The mechanism of postural vasoconstriction in the skin of the foot was examined in 102 healthy subjects by using laser Doppler flowmetry. 2. In 45 subjects, when one foot was lowered 50 cm below heart level and the other foot kept horizontal, blood flow was progressively reduced in the dependent foot (by 79%) with a concomitant, but less pronounced, reduction in flow in the horizontal foot (by 18%), indicating that a central mechanism is involved. After lumbar sympathetic blockade (in 10 patients with epidural anaesthesia), the flow in the horizontal foot remained virtually constant, indicating that the central component is mainly mediated via efferent sympathetic nerves, whereas the postural fall in flow in the dependent foot, though partially attenuated, was preserved, indicating that a local mechanism is mainly involved. 3. On lowering one foot below heart level in 12 subjects, there was a small but significant reduction in systolic and mean arterial pressures during the first minute of dependency. During the fourth minute, systolic pressure decreased, diastolic pressure and heart rate increased, but the mean arterial pressure was maintained. 4. In 19 subjects postural vasoconstriction was nearly abolished during local nervous blockade (lignocaine 3.7 × 10−4–7.4 × 10−2 mol/l), indicating that the local mechanism mediating the vasoconstriction is mainly neurogenic in nature. However, there was still a small fall (19%) in flow in the dependent foot during blockade, probably indicating a minor contribution of a local myogenic mechanism. 5. In three subjects, application of venous occlusion of 40 mmHg with the foot at heart level reduced the flow by 63% at rest, and by only 12% during local nervous blockade, indicating that the increased venous pressure on dependency provides the main stimulus for postural vasoconstriction. However, a greater reduction in flow was observed in 13 subjects when the foot was lowered 50 cm below the heart (75%) than during venous occlusion of 40 mmHg (52%) with foot at heart level, indicating that not only the increase in venous pressure but also the increase in arterial transmural pressure is implicated in the postural increase in precapillary resistance. 6. It is concluded that postural vasoconstriction in the human foot is mainly produced by a local neurogenic mechanism with a small contribution from a local myogenic response, in addition to a centrally elicited sympathetic component.

The treatment of venous leg ulcers with a specifically designed compression stocking kit

Phlebologie ◽  
2008 ◽  
Vol 37 (04) ◽  
pp. 191-197 ◽  
Author(s):  
V. Mattaliano ◽  
G. Mosti ◽  
V. Gasbarro ◽  
M. Bucalossi ◽  
W. Blättler ◽  
...  
Keyword(s):  
Patient Characteristics ◽  
Compression Stocking ◽  
Leg Ulcers ◽  
Compression Stockings ◽  
Venous Leg Ulcers ◽  
Venous Ulcers ◽  
Time To Completion ◽  
Validated Questionnaire ◽  
First Choice ◽  
Ankle Movement

SummaryTraditionally, venous leg ulcers are treated with firm nonelastic bandages. Medical compression stockings are not the first choice although comparative studies found them equally effective or superior to bandages. Patients, methods: We report on a multi-center randomized trial with 60 patients treated with either short stretch multi-layer bandages or a two-stocking system (Sigvaris® Ulcer X® kit). Three patients have been excluded because their ankle movement was restricted to the extent that they could not put on the stockings and 1 patient withdrew consent. Patient characteristics and ulcer features were evenly distributed. The proportion of ulcers healed within 4 months and the time to completion of healing were recorded. Subjective appraisal was assessed with a validated questionnaire. Results: Complete wound closure was achieved in 70.0% (21 of 30) with bandages and in 96.2% (25 of 26) with the ulcer X kit (p = 0.011). Ulcers with a diameter of up to about 4cm healed twice as rapidly, the larger ones as fast with the stocking kit as with bandages. The sum of problems encountered with bandages was significantly greater than that observed with the stocking kit (p < 0.0001). Pain at night and in the morning was absent with stockings but reported by 40% and 20% in the bandage group, respectively. The cardinal features associated with delayed or absent healing were ulcer size and pain. Conclusions: Common venous ulcers can readily be treated with the ulcer X compression kit provided the ankle movement allow its painless donning. Bandages, even when applied by the most experienced staff are less effective and cause more problems.

The Effect of Venous Occlusion on the Sequestration of Blood Platelets

1972 ◽  
Vol 28 (03) ◽  
pp. 383-392 ◽  
Author(s):  
J Hladovec ◽  
Z Koleilat ◽  
I Přerovský
Keyword(s):  
Blood Platelets ◽  
Venous Blood ◽  
Venous Occlusion ◽  
Blood Samples ◽  
Pronounced Decrease ◽  
Platelet Counts ◽  
Human Volunteers ◽  
Opposite Change

SummaryThe venous occlusion of all four legs in rats caused a highly significant decrease of platelet counts in venous blood especially after the correction for an opposite change in haematocrit. A very pronounced decrease in platelets was observed in human volunteers after a venostasis in one arm in the blood drawn from the occluded limb just before the release of occlusion. Similar decreases were found after a venostasis of both legs in postocclusion blood samples. The decrease in blood platelets results from temporary sequestration in the occluded limbs. The decreases of platelets after a 10 min occlusion of both legs are more pronounced in patients with post thrombotic states.

Open-Label Study to Evaluate the Healing Rate and Safety of the Profore™ Extra Four-Layer Bandage System in Patients with Venous Leg Ulceration

2000 ◽  
Vol 4 (1) ◽  
pp. 8-11 ◽  
Author(s):  
Aditya K. Gupta ◽  
Joel De Koven ◽  
Robert Lester ◽  
Neil H. Shear ◽  
Daniel N. Sauder
Keyword(s):  
Healing Rate ◽  
The Elderly ◽  
Leg Ulcers ◽  
Open Label ◽  
Open Label Study ◽  
Label Study ◽  
Venous Leg Ulcers ◽  
Initial Event ◽  
Venous Ulcers ◽  
High Compression

Background: Venous ulcers are increasing in prevalence, especially since these are observed more frequently in the elderly, and the number of individuals in this age group is becoming a larger portion of the population. Objective: To determine the healing rate and safety of the Profore™ Extra Four-Layer Bandage System in the management of venous leg ulcers. Methods: In an open-label study, patients aged 18 years or older with venous leg ulcers were treated with a high compression four-layer bandage system in which a hydrocellular dressing was placed in contact with the wound. The combination is designated the “Profore Extra Four-Layer Bandage System.” Follow-up visits took place weekly unless there was heavy exudation from the ulcer or if there was marked edema of the leg at the start of the study requiring reapplication of the bandage system. Results: Fifteen patients were entered into the study (men 8, women 7, mean age 66 years, mean duration of ulcers 1.3 years). Thirteen of the 15 patients completed the study, with two withdrawals. In one patient who withdrew, the ulcer became infected and required treatment with antibiotics. The other termination from the study occurred for reasons unrelated to treatment. The ulcer in this patient healed in 7 weeks. Ten of the 13 patients (77%) who completed the study, and 10 (67%) of 15, who had enrolled experienced complete (100%) healing. Healing of > 80% of the ulcers occurred in 11 of 13 patients (85%) who completed the study and in 12 (80%) of 15 enrolled patients. No patient experienced a study-related adverse event. One patient developed contact dermatitis and was later found to have stasis dermatitis. It is unclear whether the initial event was contact or stasis dermatitis. Conclusion: In this open-label study, a high compression system, using the Profore Extra Four-Layer Bandage with a hydrocellular dressing in contact with the wound, was found to be effective and safe for the treatment of venous leg ulcers.

Sign in / Sign up

Export Citation Format

Share Document