Clinical research study
Venous laboratory
Reflux volume is determined by ejected blood volume from the calf venous reservoir

https://doi.org/10.1016/j.jvsv.2020.01.005Get rights and content
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Abstract

Objective

This study investigated the relationship between the ejected blood volume from the calf venous reservoir and the reflux volume (RV) during the automatic cuff inflation-deflation maneuver in limbs with incompetent great saphenous vein.

Methods

There were 48 patients with chronic venous disease (C1-5, Ер, Аs, Pr2,3) included in the study. A noncycling operator-dependent distal cuff inflation-deflation was used as the reflux-provoking maneuver. Duplex ultrasound was used to measure the cross-sectional area of the common femoral vein and great saphenous vein as well as hemodynamic parameters (time-averaged mean velocity and flow duration) of the outflow during cuff inflation and reflux during cuff deflation. The cuff pressure was set at 60, 90, and 120 mm Hg sequentially. The RV flow rate (Q), RV, anterograde ejection volume (EV), and ratio RV/EV (reflux index, IR) were calculated for each pressure setting.

Results

RV correlated with EV and Qreflux (r2 = 0.366 and r2 = 0.647, respectively; P < .0001). Qreflux was not significantly different between different cuff inflation pressures. RV and EV were statistically different at different cuff pressure settings (analysis of variance, P < .0001). The IR was almost identical at different pressure settings (0.43 ± 0.23 at 60 mm Hg, 0.43 ± 0.20 at 90 mm Hg, and 0.42 ± 0.19 at 120 mm Hg).

Conclusions

The amount of reflux is primarily determined by the value of EV in a distal cuff compression-decompression maneuver. Both the ratio RV/EV (IR) and RV were related to the severity of the disease, more severe forms having larger IR and RV values.

Keywords

Venous reflux
Ejection volume
Reflux volume
Duplex ultrasound
Calf muscle pump
Varicose veins

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Author conflict of interest: none.

The editors and reviewers of this article have no relevant financial relationships to disclose per the Journal policy that requires reviewers to decline review of any manuscript for which they may have a conflict of interest.