Deep Venous Thrombosis: A Prospective 3-Month Follow-up Using Duplex Scanning and Strain-Gauge Plethysmography

1998 ◽  
Vol 94 (6) ◽  
pp. 651-656 ◽  
Author(s):  
M. C. H. Janssen ◽  
H. Wollersheim ◽  
J. H. Haenen ◽  
W. N. J. C. van Asten ◽  
TH. Thien
Keyword(s):  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Clinical Symptoms ◽  
Calf Muscle ◽  
Duplex Scanning ◽  
Pump Function ◽  
Muscle Pump ◽  
Calf Muscle Pump ◽  
Function Test

1. The purpose of the study was to evaluate the degree of thrombus regression, development of valvular insufficiency, impaired calf muscle pump function and clinical symptoms after a period of acute deep venous thrombosis. 2. Seventy patients with acute deep venous thrombosis, diagnosed by duplex scanning or venography, received treatment with heparin and oral coumarin derivatives according to a standard protocol. All patients wore graduated compression stockings during the whole study period. Duplex scanning was performed at diagnosis and 1 and 3 months later to measure thrombus mass and reflux. The supine venous pump function test was used to assess calf muscle pump function. 3. Three months follow-up was completed in 60 patients. In total 218 (28%) out of 780 vein segments were initially thrombosed and 134 (17%) could not be traced. A statistically significant reduction of thrombus mass was recorded throughout the study period. Total resolution of thrombosis in all vein segments occurred in 25% of the patients within 1 month and in 40% in 3 months. There was no difference in regression between the various proximal vein segments. Distal segments showed more regression than proximal segments. Reflux occurred in 27% of the initially thrombosed veins and in 15% of the patent veins. Patients who showed total resolution after 1 month had a significantly higher calf muscle pump function than patients without total resolution (70%pf vs 61%pf, P < 0.05). Patients with reflux in two or more segments had a significantly lower calf muscle pump function than patients with reflux in less than two segments (58%pf vs 69%pf, P < 0.05). 4. Using duplex scanning and the supine venous pump function test 3 months after an acute deep venous thrombosis, overall haemodynamic abnormalities and local site of valve incompetence could readily be identified. Patients with haemodynamic abnormalities might be at risk to develop the post-thrombotic syndrome. There was no difference in thrombus regression between the various proximal vein segments. Reflux was significantly more often seen in initially thrombosed veins. Thirty-five percent of the patients developed an abnormal calf muscle pump function after 3 months. Patients with early resolution of thrombus had a higher calf muscle pump function after 3 months.

scholarly journals The development of postthrombotic syndrome in relationship to venous reflux and calf muscle pump dysfunction at 2 years after the onset of deep venous thrombosis

2002 ◽  
Vol 35 (6) ◽  
pp. 1184-1189 ◽  
Author(s):  
José H. Haenen ◽  
Mirian C.H. Janssen ◽  
Hub Wollersheim ◽  
Martin A. Van't Hof ◽  
M.J.M. de Rooij ◽  
...  
Keyword(s):  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Calf Muscle ◽  
Postthrombotic Syndrome ◽  
Venous Reflux ◽  
Muscle Pump ◽  
Calf Muscle Pump

Venous reflux has a limited effect on calf muscle pump dysfunction in post-thrombotic patients

2000 ◽  
Vol 98 (4) ◽  
pp. 449-454 ◽  
Author(s):  
José H. HAENEN ◽  
Mirian C. H. JANSSEN ◽  
Alphonsus J. M. BRAKKEE ◽  
Herman VAN LANGEN ◽  
Hub WOLLERSHEIM ◽  
...  
Keyword(s):  
Calf Muscle ◽  
Duplex Scanning ◽  
Valsalva Manoeuvre ◽  
Venous Reflux ◽  
Venous Outflow ◽  
Limited Effect ◽  
Reflux Time ◽  
Pump Function ◽  
Muscle Pump ◽  
Calf Muscle Pump

The purpose of the present study was to evaluate the relationship between calf muscle pump dysfunction (CMD) and the presence and location of valvular incompetence. Deep vein obstruction might influence CMD, and so venous outflow resistance (VOR) was measured. VOR and calf muscle pump function were measured in 81 patients, 7–13 years after venographically confirmed lower-extremity deep venous thrombosis. The supine venous pump function test (SVPT) measures CMD, and the VOR measures the presence of venous outflow obstructions, both with the use of strain-gauge plethysmography. Valvular incompetence was measured using duplex scanning in 16 vein segments of one leg. Venous reflux was measured in proximal veins using the Valsalva manoeuvre, and in the distal veins by distal manual compression with sudden release. Abnormal proximal venous reflux was defined as a reflux time of more than 1 s, and abnormal distal venous reflux as a reflux time of more than 0.5 s. No statistically significant relationship was found between the SVPT and either the location or the number of vein segments with reflux. Of the 81 patients, only nine still had an abnormally high VOR, and this VOR showed no relationship with the SVPT. In conclusion, venous reflux has a limited effect on CMD, as measured by the SVPT. The presence of a venous outflow obstruction did not significantly influence the SVPT. Duplex scanning and the SVPT are independent complementary tests for evaluating chronic venous insufficiency.

scholarly journals Validation of the Supine Venous Pump Function Test: A New Non-Invasive Tool in the Assessment of Deep Venous Insufficiency

1996 ◽  
Vol 91 (4) ◽  
pp. 483-488 ◽  
Author(s):  
M. C. H. Janssen ◽  
J. A. H. R. Claassen ◽  
W. N. J. C. Van Asten ◽  
H. Wollersheim ◽  
M. J. M. De Rooij ◽  
...  
Keyword(s):  
Venous Insufficiency ◽  
Normal Values ◽  
Venous Pressure ◽  
Calf Muscle ◽  
Pressure Measurements ◽  
Limits Of Agreement ◽  
Pump Function ◽  
Non Invasive ◽  
Calf Muscle Pump ◽  
Function Test

1. A new non-invasive test was developed to assess calf muscle pump function: the supine venous pump function test. The technique uses strain-gauge plethysmography and is performed in the supine position. The method is superior to other non-invasive methods because basically the most essential haemodynamic parameter, venous pressure decrease, is used by properly converting venous volume measurements into venous pressure. The validity of this test was established by comparison with invasive venous pressure measurements and by determining the reproducibility. Additionally, normal values were determined. 2. In 28 extremities the supine venous pump function test was performed simultaneously with invasive venous pressure measurements. The reproducibility of the test was assessed in 10 randomly chosen volunteers. In 34 volunteers normal values were obtained and 26 patients with clinical venous insufficiency were examined. 3. Comparison of the two methods revealed a correlation coefficient of r = 0.98 (P < 0.001). A mean difference of 3.9%pf between both methods was found with limits of agreement of − 6.3%pf to 14.1%pf. The coefficient of repeatability was 13%pf and the coefficient of variation was 9%. The normal range was found to be >60%pf. The mean pump function in the patient group was 45%pf. 4. The limits of agreement are small enough to be confident that the supine venous pump function test can be used instead of invasive venous pressure measurements to assess calf muscle pump function in clinical practice. The reproducibility of the test is good.

scholarly journals IP263 Effect of Total Knee Arthroplasty on Calf Muscle Pump Function

2017 ◽  
Vol 65 (6) ◽  
pp. 125S-126S
Author(s):  
Ryan N. Nolte ◽  
Andrew Mitchelson ◽  
Tiffany Whitaker ◽  
Douglas Hood ◽  
Kim Hodgson
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Calf Muscle ◽  
Pump Function ◽  
Muscle Pump ◽  
Calf Muscle Pump ◽  
Total Knee

scholarly journals Reduced Calf Muscle Pump Function Is a Risk Factor for Venous Thromboembolism and Mortality

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 6-7
Author(s):  
Damon E. Houghton ◽  
Aneel A. Ashrani ◽  
Ramila Mehta ◽  
David O. Hodge ◽  
David Liedl ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Venous Thromboembolism ◽  
Calf Muscle ◽  
Olmsted County ◽  
Pump Function ◽  
Muscle Pump ◽  
Vein Thrombosis ◽  
Calf Muscle Pump ◽  
The Mean ◽  
Deep Vein

Background: Venous return from the lower extremities is pumped upwards to the right side of the heart in a process that is facilitated by one-way valves and the venous muscle pump, of which the calf muscle pump is a major contributor1-3. Venous plethysmography can quantitatively assess calf pump function (CPF). The association between the CPF and venous thromboembolism (VTE) has not been investigated. Methods: Venous plethysmography (VP) data (strain gauge or air plethysmography) from the Mayo Clinic Vascular Lab database (1998-2015) of CPF (bilaterally reduced, unilaterally reduced, and bilateral normal) were examined in Olmsted County Residents. The Rochester Epidemiology Project (REP) captures the population of Olmsted County and contains demographic information, medical diagnoses, hospital admissions, and surgical procedures as well as validated VTE events and death. Patients with signs of obstructed outflow in either extremity on the venous plethysmography (a possible sign of acute or chronic deep vein thrombosis) study were excluded. Patients with a history of VTE diagnosed before the physiologic study were also excluded. If more than one measurement of calf muscle pump function was performed, only the first measurement was used. The primary outcome was a composite of any VTE, including proximal and distal deep vein thrombosis (DVT) and pulmonary embolism (PE). Results: 1703 Olmsted County residents had venous plethysmography studies performed. MN research authorization was denied in 64 patients and 107 were excluded for any documented VTE preceding index VP study. 1532 patients with recorded CPF (28% air and 72% strain gauge plethysmography) were studied: 591 (38.5%) had normal CPF, 353 (23.0%) had unilateral reduced CPF (rCPF), and 588 (38.3%) had bilateral rCPF. The mean age was 64.4 (SD 18.4), 68.9% were female, and the mean BMI was 29.5 (SD 6.4). Any VTE occurred in 87 patients (5.7%) after a mean follow up of 10.9 years (range 0-22.0 years). Isolated lower extremity DVT (excluding concurrent PE) occurred in 49 patients and PE+/-DVT occurred in 38 patients. Death occurred in 352 patients (23%). Bilateral rCPF compared to bilateral normal CPF was associated with VTE (p=0.007), DVT only (p=0.02) and death (p&lt;0.001) but not PE+/-DVT (p=0.13). Unilateral rCPF compared to bilateral normal CPF was not associated with VTE, but was associated with death (p&lt;0.001). Kaplan-Meier curves for VTE and death are shown in Figure 1. The hazard ratio for bilateral rCPF compared to bilateral normal CPF for VTE was 2.0 (95% CI 1.2-3.4) and for DVT only was 2.2 (95% CI 1.1-4.2). A sensitivity analysis for the main outcome of VTE did not show significant interaction based on the type of plethysmography (strain vs. air), by age stratified at 65 years, sex, or BMI stratified at 30 (p&gt;0.1 for each comparison). Conclusion: In this population-based study of Olmsted County residents with no prior VTE, rCPF function as measured by venous plethysmography is associated with increased risk for VTE, particularly lower extremity proximal DVT. More research is required to understand what additional measures of venous physiology influence these findings and whether CPF could be used in VTE risk stratification. Disclosures No relevant conflicts of interest to declare.

The Effect of Lower Limb Cast Immobilization on Calf Muscle Pump Function

2014 ◽  
Vol 35 (5) ◽  
pp. 429-433 ◽  
Author(s):  
Ben A. Hickey ◽  
Amy Morgan ◽  
Neil Pugh ◽  
Anthony Perera
Keyword(s):  
Lower Limb ◽  
Calf Muscle ◽  
Cast Immobilization ◽  
Pump Function ◽  
Muscle Pump ◽  
Calf Muscle Pump
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