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Pulsatile Venous Flow
in Legs
Alexandru Andritoiu, Cristian Silosi, Maria Mitrica
Spitalul Clinic Militar
Centrul de Medicina vasculara
CRAIOVA
Normal venous flow
Characteristics:
• Phasicity –flow changes with respiration
• Spontaneity-spontaneous flow without augmentation
• Compression –transverse plane
• Augmentation/Valsalva response
• Independent from heart pulsations
Proximal-Distal Venous Flow
• CFV S Fem V
• Pop V Posterior
tibial v.
Augmentation
Posterior tibial vein
Hemodinamics
• Mult mai complexa decat hemodinamica arteriala
• Multiple influente hemodinamice
-presiunea dinamica
-presiunea hidrostatica
Pulsatile Venous Flow
• A hemodynamic curiosity?
• An abnormal condition?
• Sincron cu pulsatiile inimii
• In deep venous system
• In superficial venous system
Pulsatile flow in healthy people
Pulsatile venous flow in abnormal conditions
• Heart disease (RHF)-higher pressure in RA >7 mmHg
• Severe CVI (CEAP4-6)
• A-V fistula
Pulsatile venous flow in R-HF
• Edeme bilaterale
• Sufluri cardiace
• Istoric de boala cardiaca
-maladii congenitale
-valvulopatii (Tc)
Eco Doppler cord:
-regurgitare Tc severa (gr3-4)
-VD si AD dilatate
-VCI/-Vv. hepatice dilatate
B. Toma, 75 ani, CHF-cls. 3
Pulsatile venous flow in CVI
• Venous hypertension (CEAP4-6)
• After GSV ablation, pulsatile flow in deep venous system remain the
same!
Of the 101 limbs, 47 (46.5%) had evidence of pulsatile flow in the lower-
extremity venous system preoperatively. Paired observations using the
Wilcoxon method showed no difference in the venous pulsatility post
ablation regardless of the presence of deep venous reflux
Pulsatile flow in A-V fistula
• Fistula A-V
• Localization:
-in legs: Fem>Pop>tibial vv
• Congenital
• Post-traumatic fistula
• Post-interventional procedures
• Dialysis (arm)
A-V fistula as a vascular access
for hemodialysis
• Surgically created connection
Stepansky F et al. Radiographics 2008;28:e28-e28
Clinical case:
B. Dumitru, 57yr
• CVI 4CEAP-left leg
• varicose veins
• multiple episodes of thrombophlebitis
• refractory to medical treatment
(OAC, sulodexid, VAD, stocking)
• many times admitted to hospital (3-4 x/yr)
• Ankylosing spondylitis
Venous CDUS exam.
• Pulsatile flow in deep and superficial venous system
• No heart disease
normal ECG/echocardiography
• subcutaneous venous edema-left leg
GSV with pulsatile flow
Varicose veins with pulsatile flow
Perforator vein with pulsatile flow
Fem. A-V fistula
CT-angio
• Femoral A-V fistula
• Congenital?
Evolution/Prognosis
• very high venous pressure! How thrombophlebitis can occur?
• secondary cause for varicose veins
• danger for a refractory (hemorrhagic) ulcer?
• endovascular ablation of left GSV? No!!!
• no therapeutic solution for AVF (high surgical risk)
Conclusions
• Fluxul venos pulsatil poate fi intalnit la nivelul membrelor inferioare
• Asociat edemului bilateral-cauza cardiaca (cresterea PAD>7 mmHg)
• Asociat edemului unilateral-cauta o posibila fistula A-V
• Boala venoasa poate coexista frecvent cu suferinta cardiaca
• Boala venoasa poate fi consecinta unei fistule A-V
• Fluxul venos pulsatil la nivelul mm. inferioare poate fi de cauza
complexa-multifactoriala

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PULSATILE VENOUS FLOW IN LEGS

  • 1. Pulsatile Venous Flow in Legs Alexandru Andritoiu, Cristian Silosi, Maria Mitrica Spitalul Clinic Militar Centrul de Medicina vasculara CRAIOVA
  • 2. Normal venous flow Characteristics: • Phasicity –flow changes with respiration • Spontaneity-spontaneous flow without augmentation • Compression –transverse plane • Augmentation/Valsalva response • Independent from heart pulsations
  • 3. Proximal-Distal Venous Flow • CFV S Fem V • Pop V Posterior tibial v.
  • 5. Hemodinamics • Mult mai complexa decat hemodinamica arteriala • Multiple influente hemodinamice -presiunea dinamica -presiunea hidrostatica
  • 6. Pulsatile Venous Flow • A hemodynamic curiosity? • An abnormal condition? • Sincron cu pulsatiile inimii • In deep venous system • In superficial venous system
  • 7. Pulsatile flow in healthy people
  • 8. Pulsatile venous flow in abnormal conditions • Heart disease (RHF)-higher pressure in RA >7 mmHg • Severe CVI (CEAP4-6) • A-V fistula
  • 9. Pulsatile venous flow in R-HF • Edeme bilaterale • Sufluri cardiace • Istoric de boala cardiaca -maladii congenitale -valvulopatii (Tc) Eco Doppler cord: -regurgitare Tc severa (gr3-4) -VD si AD dilatate -VCI/-Vv. hepatice dilatate
  • 10.
  • 11. B. Toma, 75 ani, CHF-cls. 3
  • 12. Pulsatile venous flow in CVI • Venous hypertension (CEAP4-6) • After GSV ablation, pulsatile flow in deep venous system remain the same! Of the 101 limbs, 47 (46.5%) had evidence of pulsatile flow in the lower- extremity venous system preoperatively. Paired observations using the Wilcoxon method showed no difference in the venous pulsatility post ablation regardless of the presence of deep venous reflux
  • 13. Pulsatile flow in A-V fistula • Fistula A-V • Localization: -in legs: Fem>Pop>tibial vv • Congenital • Post-traumatic fistula • Post-interventional procedures • Dialysis (arm)
  • 14. A-V fistula as a vascular access for hemodialysis • Surgically created connection Stepansky F et al. Radiographics 2008;28:e28-e28
  • 15. Clinical case: B. Dumitru, 57yr • CVI 4CEAP-left leg • varicose veins • multiple episodes of thrombophlebitis • refractory to medical treatment (OAC, sulodexid, VAD, stocking) • many times admitted to hospital (3-4 x/yr) • Ankylosing spondylitis
  • 16. Venous CDUS exam. • Pulsatile flow in deep and superficial venous system • No heart disease normal ECG/echocardiography • subcutaneous venous edema-left leg
  • 18. Varicose veins with pulsatile flow
  • 19. Perforator vein with pulsatile flow
  • 21. CT-angio • Femoral A-V fistula • Congenital?
  • 22. Evolution/Prognosis • very high venous pressure! How thrombophlebitis can occur? • secondary cause for varicose veins • danger for a refractory (hemorrhagic) ulcer? • endovascular ablation of left GSV? No!!! • no therapeutic solution for AVF (high surgical risk)
  • 23. Conclusions • Fluxul venos pulsatil poate fi intalnit la nivelul membrelor inferioare • Asociat edemului bilateral-cauza cardiaca (cresterea PAD>7 mmHg) • Asociat edemului unilateral-cauta o posibila fistula A-V • Boala venoasa poate coexista frecvent cu suferinta cardiaca • Boala venoasa poate fi consecinta unei fistule A-V • Fluxul venos pulsatil la nivelul mm. inferioare poate fi de cauza complexa-multifactoriala