scholarly journals Features of venous blood circulation and valve function in the lower extremities according to duplex scanning data and morphofunctional studies

2021 ◽  
Vol 102 (5) ◽  
pp. 597-605
Author(s):  
I M Ignatyev ◽  
V V Evseeva ◽  
S Yu Ahunova ◽  
E G Gradusov
Keyword(s):  
Early Diagnosis ◽  
Blood Circulation ◽  
Prognostic Value ◽  
Varicose Veins ◽  
Venous Blood ◽  
Duplex Ultrasound ◽  
Venous System ◽  
Ultrasound Scanning ◽  
Valve Function ◽  
Valvular Insufficiency

Aim. To study the mechanisms of venous return and the functioning features of lower extremity venous valves in horizontal and vertical positions. Methods. The study, conducted from April 2019 to December 2020, included 100 people. The study participants were divided into 2 groups. The first group was represented by 44 patients (88 limbs) with varicose veins, whose venous system was examined by duplex ultrasound scanning during inpatient rehabilitation. The second (control) group consisted of 56 healthy individuals (92 limbs) without visible signs of venous pathology who underwent an outpatient examination of the venous system. The average age of the patients in the two groups was 49.22.4 and 51.11 years, respectively; women predominated in both groups. The qualitative and quantitative parameters of venous blood flow were studied in the study. Venous valvular insufficiency was assessed by using reflux duration and the Psatakis index. A morphometric study was conducted on 140 limbs of 48 human corpses, from which venous fragments were taken for biomechanical studies of the valves. The clinical characteristics of patients are presented by descriptive statistics, quantitative parameters are reported as the mean value (M) and standard deviation (SD). The differences were tested for significance by using the Student's t-test. Results. In the study, we introduced the concept of the valve index, the aspect ratio of the ellipse, the shape of which has a venous valve in cross-section. Duplex ultrasound scanning, as well as a morphofunctional examination of the valves, made it possible to establish that the valve index is significantly higher in the presence of signs of varicose veins, which indicates dilation and incipient varicose vein, which leads to valvular insufficiency. The elasticity index defined by us, as the indicator of change in the venous lumen size, measured by the ratio of its diameters, also significantly (p=0.034) differed in the studied groups: the elasticity index in the group of healthy people was 1.370.11, in the group of patients with varicose veins 1.560.17. The studied factors allowed us to develop a test that has an important prognostic value for the early diagnosis of varicose veins as well as the implementation of preventive health measures. Conclusion. The features of venous blood circulation and valve function studied in the study not only have prognostic value for the early diagnosis of varicose veins but are also of practical interest for developing methods of surgical correction of venous valvular insufficiency.

Duplex Ultrasound Scanning for Chronic Venous Disease: I. Techniques for Examination of the Crural Veins

1994 ◽  
Vol 9 (3) ◽  
pp. 108-113 ◽  
Author(s):  
R. W. Ziegenbein ◽  
K. A. Myers ◽  
P. G. Matthews ◽  
G. H. Zeng
Keyword(s):  
Venous Insufficiency ◽  
Outcome Measure ◽  
Varicose Veins ◽  
Duplex Ultrasound ◽  
Chronic Venous Disease ◽  
Venous Disease ◽  
Ultrasound Scanning ◽  
Diagnostic Laboratory ◽  
Non Invasive ◽  
Anterior Tibial

Objective: To describe a practical technique to reliably find and study crural veins by duplex ultrasound scanning. Design: Prospective scanning of patients referred for evaluation of possible chronic deep venous insufficiency. Setting: A non-invasive vascular diagnostic laboratory in Melbourne, Australia. Patients: A study of 1340 legs in 917 consecutive patients referred with primary or recurrent varicose veins, or for evaluation of possible deep venous disease causing aching or swelling in the legs. Interventions: Examination of the crural veins by duplex ultrasound scanning. Main outcome measure: Identification of all three sets of crural veins. Results: Rates for detecting the posterior tibial, anterior tibial and peroneal veins were 97%, 92% and 91% respectively and all three were observed in 91%. If the last 1227 legs studied by colour-Doppler duplex ultrasound are considered, the rates for detection were 98%, 96% and 96% respectively. Conclusion: Examination of the crural veins can be a part of routine duplex ultrasound scanning in patients referred with suspected venous disease.

Extrajugular pathways of human cerebral venous blood drainage assessed by duplex ultrasound

2003 ◽  
Vol 94 (5) ◽  
pp. 1802-1805 ◽  
Author(s):  
Stephan J. Schreiber ◽  
Frank Lürtzing ◽  
Rainer Götze ◽  
Florian Doepp ◽  
Randolf Klingebiel ◽  
...  
Keyword(s):  
Blood Volume ◽  
Venous Blood ◽  
Duplex Ultrasound ◽  
Venous Drainage ◽  
Volume Flow ◽  
Venous System ◽  
Jugular Veins ◽  
Ultrasound Studies ◽  
Cerebral Venous Drainage ◽  
Venous Blood Volume

Cerebral venous drainage in humans is thought to be ensured mainly via the internal jugular veins (IJVs). However, anatomic, angiographic, and ultrasound studies suggest that the vertebral venous system serves as an important alternative drainage route. We assessed venous blood volume flow in vertebral veins (VVs) and IJVs of 12 healthy volunteers using duplex ultrasound. Measurements were performed at rest and during a transient bilateral IJV and a circular neck compression. Total venous blood volume flow at rest was 766 ± 226 ml/min (IJVs: 720 ± 232, VVs: 47 ± 33 ml/min). During bilateral IJV compression, VV flow increased to 128 ± 64 ml/min. Circular neck compression, causing an additional deep cervical vein obstruction, led to a further rise in VV volume flow (186 ± 70 ml/min). As the observed flow increase did not compensate for IJV flow cessation, other parts of the vertebral venous system, like the intraspinal epidural veins and the deep cervical veins, have to be considered as additional alternative drainage pathways.

Assessment of Lower Extremity Venous Valvular Insufficiency Examinations

2005 ◽  
Vol 29 (3) ◽  
pp. 123-129 ◽  
Author(s):  
Terry Needham
Keyword(s):  
Lower Extremity ◽  
Ultrasound Imaging ◽  
Continuous Wave ◽  
Varicose Veins ◽  
Duplex Ultrasound ◽  
Venous Hypertension ◽  
Venous Reflux ◽  
Reduced Pressure ◽  
Continuous Wave Doppler ◽  
Valvular Insufficiency

Usually, venous insufficiency affecting an extremity results from elevated pressure, whereas arterial insufficiency usually is caused by reduced pressure energy. Except when caused by arteriovenous fistulae, elevated venous pressures are caused by obstruction to outflow and/or by incompetence of the venous valves, particularly at popliteal level and in the calf perforator veins. In the lower extremity, such elevated venous pressures can result in chronic changes that cause symptoms and/or signs that range from “tired legs” to ulceration. Although mild venous hypertension may constitute only a relative inconvenience such as varicose veins, more severe cases can lead to debilitating ulceration that may demand a change in lifestyle. Assessing an extremity for venous valvular insufficiency means detecting venous reflux. This work describes the plethysmographic, continuous-wave Doppler, and duplex ultrasound imaging modalities that can be used for detecting venous reflux in the deep, superficial, and perforating veins. Although plethysmographic and continuous-wave Doppler modalities have been supplanted largely by duplex ultrasound imaging, they have been included for completeness because they can continue to fulfill a role in overall functional assessment. Whatever the testing modality used to assess venous reflux, it is essential to verify the patency of the deep veins before any intervention in the superficial venous system.

Duplex Ultrasound Scanning for Chronic Venous Disease: Recurrent Varicose Veins in the Thigh after Surgery to the Long Saphenous Vein

1996 ◽  
Vol 11 (3) ◽  
pp. 125-131 ◽  
Author(s):  
K. A. Myers ◽  
G. H. Zeng ◽  
R. W. Ziegenbein ◽  
P. G. Matthews
Keyword(s):  
Saphenous Vein ◽  
Varicose Veins ◽  
Duplex Ultrasound ◽  
Chronic Venous Disease ◽  
Injection Sclerotherapy ◽  
Venous Disease ◽  
Ultrasound Scanning ◽  
Recurrent Varicose Veins ◽  
Long Saphenous Vein ◽  
Primary Varicose Veins

Objective: To use duplex ultrasound scanning to compare limbs with recurrent and primary varicose veins and to identify connections between deep veins and recurrences. Setting: A non-invasive vascular laboratory in Melbourne, Australia. Patients: A study of 779 limbs with recurrent varicose veins previously treated by ligation or stripping of the long saphenous vein and 1521 limbs with primary varicose veins. Main outcome measures: Connections between deep veins and recurrent varices, reflux in superficial and deep veins, and outward flow in perforators as demonstrated by duplex ultrasonography. Results: Recurrence was due to reflux in the long saphenous territory in 71.8%, short saphenous reflux alone in 14.7% or outward flow in calf perforators without saphenous reflux in 5.2%, while no source was detected in 8.3%. Limbs with recurrent veins in the long saphenous territory were compared with limbs with primary varicose veins; there was more frequent outward flow in thigh perforators (25.2% vs. 16.2%) but no difference for deep reflux (20.7% vs. 17.5%) or outward flow in calf perforators (56.8% vs. 53.1%). The source for recurrence in the long saphenous territory was from a single large connection in the groin in 46.3%, multiple smaller proximal connections in a further 46.3%, or thigh perforators in 7.4%. The destination was to an intact long saphenous vein in 33.7%, major tributaries in 28.7% or to other varices in 37.6%. Limbs known to have been treated by long saphenous ligation alone were compared with those known to be treated by long saphenous ligation and stripping; the source was more likely to be from a single large vein in the groin (60.3% vs. 39.9%) and the destination was more likely to be an intact long saphenous vein or major tributary (75.0% vs. 55.2%). Conclusions: Duplex ultrasound scanning detected the source of recurrent varicose veins in over 90% of patients and demonstrated whether there were single large or multiple smaller connections in the veins affected, and this helps to select the most appropriate treatment. Recurrence after stripping the long saphenous vein was more likely to be due to multiple small connections passing to scattered varices and this may allow more simple treatment by injection sclerotherapy rather than repeat surgery.

Elevated Serum Estradiol/Testosterone Ratio in Men with Primary Varicose Veins Compared with a Healthy Control Group

Angiology ◽  
2008 ◽  
Vol 60 (3) ◽  
pp. 283-289 ◽  
Author(s):  
M. Kendler ◽  
Ch. Blendinger ◽  
E. Haas
Keyword(s):  
Sex Hormones ◽  
Varicose Veins ◽  
Clinical Stage ◽  
Venous Blood ◽  
Elevated Serum ◽  
Duplex Ultrasound ◽  
Free Testosterone ◽  
Control Group ◽  
Serum Estradiol ◽  
Healthy Men

The role of sex hormones in men with varicose veins remains unclear. Therefore, we set up a prospective pilot-study. In 34 men, venous blood was sampled during morning hours, for the determination of serum estradiol (E2), dehydroepiandrostendion, androstendion, and free testosterone (fT). Serum E2:fT ratio was calculated. The study protocol also included patient history, physical examination, color duplex ultrasound of both limbs, and assignment of CEAP clinical stage (C) classification. About 21 symptomatic varicose men (VM [C ≥ 2] mean age of 40.3/±6.9 years) and 13 healthy men (HM [C ≤ 1] mean age of 38.1/± 7.4 years) were analyzed. The serum E2:fT ratio (VM 2.83/± 0.79 and HM 2.32/±0.63) was significantly different ( P < .05) between the two groups. No major differences were seen on the serum levels of the sex hormones. In summary, our results demonstrate a changed serum E2:fT ratio among men with varicose veins compared to healthy men. By the fact of a small study sample, the interpretabillity of this result is limited.

scholarly journals Modern views on the development of varicose and post-thrombotic diseases

2020 ◽  
Vol 27 (1) ◽  
pp. 105-125 ◽  
Author(s):  
Ivan N. Shanaev
Keyword(s):  
Chronic Diseases ◽  
Varicose Veins ◽  
Modern Science ◽  
Lower Extremities ◽  
Venous System ◽  
Systemic Hemodynamic ◽  
Thrombotic Disease ◽  
Vein Thrombosis ◽  
Thrombotic Diseases ◽  
Valvular Insufficiency

Chronic diseases of the veins of the lower extremities include vascular pathologies within the venous system and exclude those, in which the veins suffer secondarily (chronic heart failure, iatrogenic damage, tumour occlusion). The main clinical and morphological forms of chronic diseases of the veins of the lower extremities include: varicose veins, post-thrombotic disease and phlebodysplasia. Moreover, according to publications, varicose disease accounts for the main percentage of occurrence, i.e. from about 70 to 86 %. Post-thrombotic disease occurs from 14 to 29 % of cases and develops, as a rule, during the first two years after an episode of deep vein thrombosis of the lower extremities in 20–50 % of patients. These two diseases are the main reason for the development of chronic venous insufficiency with a significant decrease in working capacity and quality of life under the age of 60. Despite the achievements of modern science, the ethiopathogenesis of these diseases is yet to be understood. Instrumental diagnostics allows a pathological retrograde blood fl ow due to the failure of the valves of the venous system of the lower extremities to be determined. However, the issue of what is primary — valvular insufficiency or venous wall deformation — remains open at the present time. This article is devoted to a review of modern theories about the mechanisms underpinning the formation of valvular insufficiency in varicose and post-thrombotic diseases. The review also addresses systemic hemodynamic disorders (heart morphology and hemodynamics) against the background of chronic diseases of the veins of lower extremities.

The value of thermography in the preoperative mapping of primary and recurrent varicose veins

Phlebologie ◽  
2000 ◽  
Vol 29 (05) ◽  
pp. 129-133
Author(s):  
G. Madycki ◽  
J. Grzegrzólka ◽  
W. Hendiger ◽  
W. Staszkiewicz
Keyword(s):  
Sensitivity And Specificity ◽  
Varicose Veins ◽  
Preoperative Evaluation ◽  
Duplex Ultrasound ◽  
Preoperative Assessment ◽  
Venous System ◽  
Quick Method ◽  
Simple Method ◽  
Recurrent Varicose Veins ◽  
Preoperative Mapping

SummaryAim: Despite great advances in ultrasound diagnosis of the venous system, there is still a need for a quick and simple method of complex preoperative visualisation of the superficial venous system and its incompetent perforators. The aim of the study was to assess the usefullness of thermography in the preoperative mapping of the superficial venous system among patients with primary and recurrent varicose veins. Method: Authors examined prospectively 48 patients with varicose veins (36 with primary and 12 with recurrent varicose veins). Preoperative assessment was performed by means of infrared scanning (thermography). The results were verified by colour coded duplex ultrasound and intraoperative findings. In the results, the mapping of incompetent veins by thermography unit showed an excellent correlation with colour/duplex scan and intraoperative findings. The sensitivity and specificity for thermography were 85.4% and 93.7% respectively and were lower than the values acquired by US scanning (sensitivity and specificity – 89.6% and 97.7% respectively). Conclusion: Authors conclude, that colour/duplex ultrasound remains a method of choice in the preoperative evaluation of the entire venous system, but thermography offers a simple and quick method for complex mapping of the incompetent superficial venous system. This method might prove to be a helpful adjunct to the ultrasound, particularly in case of recurrent varicose veins or in cases, when the incompetent veins are not well seen (e. g. obesity).

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.

Make it Easy: Duplex Examination of the Venous System

1993 ◽  
Vol 8 (1) ◽  
pp. 17-21 ◽  
Author(s):  
E. Kalodiki ◽  
L. Calahoras ◽  
A. N. Nicolaides
Keyword(s):  
Ultrasound Examination ◽  
Duplex Ultrasound ◽  
Venous System ◽  
Ultrasound Scanning ◽  
Single Patient ◽  
Gravitational Effects ◽  
Vein Thrombosis ◽  
Vein Imaging ◽  
Vascular Laboratory ◽  
Deep Vein

Objective: A methodological report of duplex ultrasound examination of the venous system, with Particular consideration of the best position for examining the patient. Design: Single patient group, comparison of duplex ultrasound imaging with phlebography. getting: Teaching hospital vascular laboratory. Patients: Patients referred for assessment of their venous system. Main outcome measures: Duplex ultrasound scanning of the lower limb, ascending phlebography. Results: Our results of duplex ultrasound scanning in the diagnosis of deep vein thrombosis as compared with Phlebography show a sensitivity of 94% and a specificity of 91%. Conclusions: We found it advantageous to examine the Patient standing during proximal vein imaging and sitting for distal venous examination. Veins dilated as a result of gravitational effects are visualized more easily. The examiner, by resting the elbow on his/her distal Thigh, has a more stable hand, facilitating the test. The Patient, by resting the heel on the edge of the examiner's chair, relaxes the calf muscles, thus simplifying the augmentation manoeuvre. The inflation of a tourniquet applied to the distal thigh dilates the calf veins.

A Comparison of the Effects of Electrical Calf Muscle Stimulation and the Venous Foot Pump on Venous Blood Flow in the Lower Leg

1990 ◽  
Vol 5 (4) ◽  
pp. 285-290 ◽  
Author(s):  
M. D. Laverick ◽  
R. C. McGivern ◽  
M. D. Crone ◽  
R. A. B. Mollan
Keyword(s):  
Blood Flow ◽  
Venous Blood ◽  
Duplex Ultrasound ◽  
Lower Leg ◽  
Calf Muscle ◽  
Muscle Stimulation ◽  
Venous Blood Flow ◽  
Similar Magnitude ◽  
Ultrasound Scanning ◽  
Venous Sinuses

The pattern of popliteal blood flow following electrical calf muscle stimulation and activation of the venous foot pump were studied using duplex ultrasound scanning in volunteers. The increase in velocity was of a similar magnitude for both methods, but the pattern was different, suggesting that the venous foot pump may not empty the soleal venous sinuses. Dynamic venography confirmed this hypothesis.

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