Hemodynamic Deterioration in Chronic Venous Disease.
Publication/Presentation Date
11-1-1992
Abstract
Clinical deterioration of patients with chronic venous disease (CVD) has been well described and a standardized classification has been proposed. The progressive hemodynamic deterioration producing these clinical findings is less well appreciated. This study examines and correlates venous hemodynamics with clinical severity in patients with CVD. Two hundred seventy-four extremities from 149 patients with varying degrees of CVD and 56 extremities from 28 symptom-free volunteers were evaluated clinically and hemodynamically. Each limb was assessed for functional venous volume, degree of valvular insufficiency, efficiency of the calf muscle pump, and noninvasive estimate of ambulatory venous pressure. In addition, exercise venous pressures were recorded in 56 extremities from 36 patients and 9 extremities from 6 volunteers. As CVD progresses from class 0 to class 2, venous volume expands, valvular function deteriorates, the calf muscle pump becomes inefficient, and ambulatory venous hypertension develops. However, once extremities develop brawny edema or hyperpigmentation, further deterioration of limb hemodynamics does not occur. Patients with deep venous obstruction have more severe valvular insufficiency, calf muscle pump dysfunction, and ambulatory venous hypertension than have patients without evidence of obstruction. Residual volume fraction offers a reliable noninvasive estimate of ambulatory venous pressure (r = 0.76), although its correlation was significantly better for patients without venous obstruction (r = 0.86) than for those with obstruction (r = 0.40; p < 0.05). Deterioration in venous hemodynamics parallels clinical severity through class 2. Once brawny edema and hyperpigmentation occur, ulceration develops without additional deterioration of venous hemodynamics.
Volume
16
Issue
5
First Page
733
Last Page
740
ISSN
0741-5214
Published In/Presented At
Welkie, J. F., Comerota, A. J., Katz, M. L., Aldridge, S. C., Kerr, R. P., & White, J. V. (1992). Hemodynamic deterioration in chronic venous disease. Journal Of Vascular Surgery, 16(5), 733-740.
Disciplines
Medicine and Health Sciences | Other Medical Specialties | Surgery
PubMedID
1433661
Department(s)
Department of Surgery, Department of Surgery Faculty
Document Type
Article