Calf muscle pump failure in lower limb lymphoedema

Abnormal venous haemodynamics and poor calf muscle pump may play a role in lymphoedema by contributing to production of excess interstitial fluid. Using photoplethysmography (PPG), we compared haemodynamic characteristics between normal and lymphoedematous lower limbs. PPG was performed using an automated infrared-based system, while the patient performed 10 active dorsiflexions of the ankle. This gave values for venous refilling time and venous pump power. A total of 62 limbs (normal = 37; lymphoedematous = 25) were studied. Lymphoedematous limbs showed significantly decreased venous pump power and venous refilling time (s) than normal limbs (24.6±14.1 versus 45.4±16 and 23±15.2 versus >45, respectively; P<0.005 for all the results). The haemodynamic values measured in the normal group showed good consistency and reproducibility. These results were consistent with the previous literature and demonstrate an impaired venous system associated with the development of lymphoedema. Poor muscle pump power may reflect physical disability of the ankle joint to perform dorsiflexion. This factor should be considered when treating this incurable condition.

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Quantitative Evaluation of Calf Muscle Pump Function after Deep Vein Thrombosis by Non-Invasive Venous Tests

Phlebology The Journal of Venous Disease ◽

10.1177/026835559000500111 ◽

1990 ◽

Vol 5 (1) ◽

pp. 51-59 ◽

Cited By ~ 8

Author(s):

S. Ohgi ◽

K. Tanaka ◽

T. Araki ◽

K. Ito ◽

H. Hara ◽

...

Keyword(s):

Deep Vein Thrombosis ◽

Quantitative Evaluation ◽

Calf Muscle ◽

Lower Limbs ◽

Pump Function ◽

Muscle Pump ◽

Vein Thrombosis ◽

Non Invasive ◽

Calf Muscle Pump ◽

Deep Vein

In order to quantitatively evaluate calf muscle pump function following deep vein thrombosis (DVT), expelled volume was investigated by strain gauge plethysmography (SPG). Thirty-six patients with 43 diseased lower limbs and nine healthy persons with 16 control limbs were studied. Of 43 diseased limbs, 20 symptomatic limbs were distinguished from 23 asymptomatic limbs by the presence of heaviness or aching. The following ***noninvasive parameters for the quantitative evaluation of calf muscle pump function, venous refilling time (VRT), venous outflow (VO), venous return (VR), and expelled volume (EV) were measured by SPG or photoplethysmography (DPG). Ambulatory venous pressure (AVP) was taken to represent the standard for calf muscle pump function. Using SPG, the EV, VR, and VRTs distinguished three groups (control, asymptomatic and symptomatic). Among seven indicators (EV, VR, VO, VRTs), EV had the highest correlation coefficient with the AVP ( r = +0.728). A positive EV was present in 85% of the symptomatic limbs, but in only 4% of the asymptomatic limbs. It is concluded that the EV is a useful non-invasive indicator for the quantitative evaluation of calf muscle pump function after deep vein thrombosis.

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Some features of compression therapy for early forms of chronic venous diseases of the lower limbs

Ambulatory surgery hospital-replacing technologies ◽

10.21518/1995-1477-2019-3-4-89-94 ◽

2019 ◽

pp. 89-94 ◽

Cited By ~ 1

Author(s):

V. Yu. Bogachev ◽

B. V. Boldin ◽

N. R. Arkadan ◽

V. N. Lobanov

Keyword(s):

Class Ii ◽

Calf Muscle ◽

Lower Limbs ◽

Class I ◽

Venous Disease ◽

Compression Garments ◽

Pump Function ◽

Muscle Pump ◽

Calf Muscle Pump ◽

Venous Diseases

The current compression garment selection guide is targeted at the earliest clinical stages of chronic venous disease (CVD) and assumes a priori that application of a higher class of compression improves the calf muscle pump function, which is the major mechanism promoting venous return from the lower limb to the heart.Objective of the study: to evaluate the calf muscle pump function in patients with the early forms of CVD using different classes of compression garments.Material and methods: A total of 30 patients (45 lower limbs) with Class 1 CVD (CEAP classification) were enrolled in the study. The calf muscle pump function was evaluated during wearing compression garments using remote cableless photoplethysmography of Bodytronic measurement system (Bauerfeind, Germany) with automatic data processing. The investigators measured venous refilling time (T0) and pump capacity (V0) in patients without compression garments and also in those wearing classes 0, I and II compression garments (RAL standard, Venotrain micro, Bauerfiend socks). All indicators were measured three times with an interval of 30 minutes. The final values of T0 and V0 were calculated as average.Results and discussion: when the indicators were measured without compression and with zero compression, T0 was 26.7 ± 1.2 sec and 25.4 ± 1.1 sec (p = 0.56); V0 - 8.6 ± 0.7% and 8.0 ± 0.4% (p = 0.47). When the calf muscle pump function indicators were measured using class I compression garments, its performance was improved. Thus, T0 and V0 (p <0.01) increased significantly to 38.9 ± 2.1 sec and 12.9 ± 1.4%, respectively. When the calf muscle pump function indicators were measured using class II compression garments, T0 and V0 were 38.1 ± 1.6 sec and 8.1 ± 0.6%. Thus, the use of class I compression garments significantly improved the calf muscle pump function in patients with early manifestations of CVD. The higher level of compression (class II) did not improve T0 and worsened V0. This fact can be explained by excessive compression of the muscular venous sinuses caused by wearing class 2 compression garments, which, apparently, worsened the propulsive ability of the calf pump.Conclusion: the use of class I compression garments is optimal for the management of hemodynamic disorders in patients with early forms of chronic venous diseases (C1 according to CEAP). The higher class of compression does not improve the hemodynamic parameters of the calf muscle pump.

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Calf Muscle Pump Stimulation as a Means to Reduce Symptoms of Fibromyalgia Syndrome

Biological Research For Nursing ◽

10.1177/1099800414546893 ◽

2014 ◽

Vol 17 (3) ◽

pp. 334-339 ◽

Cited By ~ 3

Author(s):

Lynn M. Baniak ◽

Carolyn S. Pierce ◽

Erik Hiester ◽

Kenneth J. McLeod

Keyword(s):

Fibromyalgia Impact Questionnaire ◽

Additional Treatment ◽

Calf Muscle ◽

Attrition Rate ◽

Widespread Pain ◽

Muscle Pump ◽

Calf Muscle Pump ◽

Revised Fibromyalgia Impact Questionnaire ◽

Change In Mean ◽

Quiet Sitting

Fibromyalgia (FM) is a debilitating chronic condition that often affects women in midlife with widespread pain that interrupts attempts to exercise. The purpose of this pilot study was to test the efficacy of calf muscle pump (CMP) stimulation as an adjuvant therapy for FM by (1) assessing the correlation of the level of symptoms, as measured by the revised Fibromyalgia Impact Questionnaire (FIQR), and blood pressure (BP), (2) measuring change in mean FIQR scores for subjects who use a CMP-stimulation device for 12 weeks, and (3) measuring the correlation of total device usage and the level of symptoms as measured by the FIQR. The 29 male and female participants (mean age = 47.3 years) were screened using the Widespread Pain Index (WPI), Symptom Severity (SS) score, and the FIQR. Participants were contacted weekly, and progress was assessed using the WPI, SS score, and the FIQR as well as general questions regarding responses to CMP stimulation. The attrition rate was high, which is not uncommon in studies of patients with FM. We found that diastolic BP was significantly inversely correlated with baseline FIQR scores during quiet sitting. Further, 12 weeks of CMP stimulation was associated with significant improvement in average FIQR scores at a rate of approximately −1.5 points per week ( R2 = .9; p ≤ .0001). Total device usage was strongly and inversely correlated with baseline FIQR scores ( R2 = .43; p = .02). These findings suggest that CMP stimulation may provide an additional treatment option for individuals with FM who are challenged to perform traditional forms of exercise.

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Calf muscle pump function as a predictor of all-cause mortality

Vascular Medicine ◽

10.1177/1358863x20953212 ◽

2020 ◽

Vol 25 (6) ◽

pp. 519-526

Author(s):

Meghana Halkar ◽

Jose Medina Inojosa ◽

David Liedl ◽

Waldemar Wysokinski ◽

Damon E Houghton ◽

...

Keyword(s):

Heart Failure ◽

Charlson Comorbidity Index ◽

Negative Impact ◽

Calf Muscle ◽

Study Objective ◽

Muscle Pump ◽

Calf Muscle Pump ◽

Comorbidity Index ◽

Predominantly Female ◽

Poor Outcomes

Calf muscle pump (CMP) promotes venous return from the lower extremity and contributes to preload and cardiac output. Impaired CMP function may reflect a measure of frailty or cumulative disease burden or may impede cardiac function. The study objective was to test the hypothesis that impaired CMP negatively impacts survival. Consecutive adult patients who underwent venous strain gauge plethysmography at the Mayo Clinic Gonda Vascular Laboratory (January 1, 1998 – December 31, 2011) were assessed for overall survival. Patients with venous incompetence, venous obstruction or unilateral calf pump dysfunction were excluded. Risk of mortality was assessed with Cox proportional hazard ratios and after adjusting for Charlson Comorbidity Index variables. Over the study period, 2728 patients were included in the analysis. Compared to patients with normal CMP, those with impaired CMP were older ( p < 0.001), predominantly female ( p = 0.01) and had higher mean Charlson scores ( p < 0.001). Patients with impaired CMP had a higher mortality rate at 5 (8.9% vs 2.4%), 10 (17.5% vs 5.9%), and 15 years (22.8% vs 8.3%) compared to those with normal CMP ( p < 0.001 for each comparison). Of patients with heart failure, those with impaired CMP had worse survival at each 5-year increment compared to those with normal CMP ( p < 0.05 at each increment). In conclusion, impaired CMP appears to be an independent predictor of poor outcomes after adjusting for variables within the Charlson Comorbidity Index. The association between impaired CMP, heart failure, and mortality may represent a negative impact on circulatory function or a surrogate measure of frailty.

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Assessment of the long term results of the treatment based on the duplication of crural fascia as improvement of calf muscle pump in patients with chronic venous insufficiency

Leczenie Ran ◽

10.1066/s10019040006 ◽

2004 ◽

Vol 1 (1-1) ◽

pp. 9-11

Author(s):

ANDRZEJ CENCORA ◽

MAREK PIWOWARCZYK ◽

MACIEJ CHWAŁA

Keyword(s):

Chronic Venous Insufficiency ◽

Venous Insufficiency ◽

Calf Muscle ◽

Long Term Results ◽

Crural Fascia ◽

Muscle Pump ◽

Calf Muscle Pump

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The Effect of Elastic Compression on Calf Muscle Pump Function

Phlebology The Journal of Venous Disease ◽

10.1177/026835559000500105 ◽

1990 ◽

Vol 5 (1) ◽

pp. 13-19 ◽

Cited By ~ 25

Author(s):

D. Christopoulos ◽

A. N. Nicolaides ◽

G. Belcaro ◽

P. Duffy

Keyword(s):

Venous Pressure ◽

Haemodynamic Effect ◽

Calf Muscle ◽

Venous Reflux ◽

Venous Capacitance ◽

Elastic Compression ◽

Muscle Pump ◽

Calf Muscle Pump ◽

Elastic Stockings ◽

Venous Volume

The haemodynamic effect of elastic compression has been evaluated in 23 patients (26 limbs) with superficial venous incompetence. Ambulatory venous pressure (AVP) and pressure recovery time (RT90) were measured with foot vein canulation. Also the functional venous volume (VV) (venous capacitance), venous reflux and the ejecting capacity of the calf muscle pump were measured with air-plethysmography. The above measurements were made with and without a graduated compression elastic stocking. Elastic compression produced a significant reduction in VV ( P < 0.01). Also a significant decrease in venous reflux and increase in the ejecting capacity of the calf muscle pump ( P < 0.01). The above alterations explain the significant reduction in AVP and prolongation of RT90 ( P < 0.01) which was observed as a result of elastic compression. The measurements made in this study demonstrate in an objective and quantitative way the beneficial effect of elastic stockings in patients with superficial venous incompetence and how this effect is achieved.

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