Etude des sequelles de thrombose veineuse profonde unilaterale par plethysmographie du mollet. [Sequelae of unilateral deep venous thrombosis in plethysmography of the calf]

Twenty four patients suffering from unilateral venous disturbances revealed by Doppler and secondary to a deep venous thrombosis were examined. The calf venous haemodynamics was analyzed by use of a strain-jauge plethysmograph. We determined the increase in venous volume due to the inflation of a thigh pneumatic cuff (pressure at 20, 40 and 60 mm Hg; delta V20, delta V40, delta V60). The maximal venous output (Vout) was measured after a quick release of the 60 mm Hg pressure. The maximal venous drainage (VMM) was assessed during a rhythmic exercise (tiptoeing) while standing; delta V20, delta V40 and delta V60 were nearly constantly reduced on the abnormal side (t of Student respectively 3.49; 6.09 and 5.07). Vout dropped proportionaly to delta V60. Some abnormalities due to valvular insufficiency were frequently present in the beginning of the inflation curve at the level of the abnormal limbs. VMM was nearly always largely decreased on the affected side (t = 5.43). The unilateral flow disturbances displayed by the Doppler were regularly going with abnormalities of the capacitive system, well demonstrated by comparison with the non-affected limbs

The quantitation of blood flow/metabolism coupling at rest and after exercise in peripheral arterial insufficiency, using PET and 15-0 labeled tracers

Regional blood flow and oxygen uptake of the lower limbs were studied in 11 patients with arterial insufficiency (10 with severe unilateral, 1 with bilateral intermittent claudication). Regional muscle blood flow (F), oxygen consumption rate (R), and oxygen extraction fraction (E) were evaluated by positron emission tomography (PET) and bolus inhalation of C15O2 and 15O2 by the patient. Tomograms were recorded at the greatest diameter of legs, at rest and ten minutes after a treadmill walk test leading to the development of ischemic pain in the affected leg. In 5 patients, F and E were correlated with the results of occlusive venous strain gauge plethysmography and with the measurements of blood gases in one brachial artery and in the femoral vein of the affected limb. Blood flow values measured at rest and after exercise by PET were poorly correlated with the plethysmographic findings. This may be because PET does not interfere with flow as venous occlusion plethysmography does in low peripheral pressure conditions. The results show that F, R, and E were not significantly different in normal and pathologic legs at rest. The values of F and R were significantly higher in pathologic than in normal lower limbs, ten minutes after exercise, whereas E was not significantly altered by exercise at any side. This suggests that, during the recovery from a walk test, the delayed increase in oxygen uptake is proportional to the delayed hyperemia in the ischemic muscles ("oxygen debt") and probably not linked to a luxury perfusion

Musculo-Venous Pump in the Elderly

We study the musculo-venous pump in an elderly population, free of venous disease, by use of a digitized photoplethysmograph. We measure the venous refilling time (To) and the venous drainage (Vo) during active and passive movement. In the first part, we measure Vo and To during active and passive ankle flexions among 17 patients (34 limbs) aged 82.2 years. These variables are compared to the results of the same measurements obtained among 15 young adults aged 45.1 years (30 limbs). We find that To and Vo are significantly lower in the oldest population (To j 35.9 +/- 4.8 sec, To aged 16.1 +/- 5.2 sec, p < 0.001, Vo j 4.98 +/- 1.1%, Vo ag 2.97 +/- 1%, p < 0.001). In the second part of this work, a passive massage of the calf is substituted to the ankle flexions. This technique is applied to 19 elderly people aged 80.4 years (37 limbs) compared to 6 young adults aged 24 years (12 limbs). In these conditions the comparison is no more in favour of the younger group (To j 37 +/- 7.5 sec, To ag 30.6 +/- 4.1 sec, Vo j 4.03 +/- 1.5%, Vo ag 3.8 +/- 0.06%). The values measured in the elderly group are in the range of normal values. We conclude that senescence does not alter the venous system itself. The present work confirms the influence of extravascular factors as muscles, understanding and coordination of the motions, articular flexibility, on the performance of the musculo venous pomp. As far as possible, the muscular and articular activity has to be encouraged in elderly people in order to reduce the venous stasis

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peer reviewe

Assessment of flow and oxygen delivery to the lower extremity in arterial insufficiency: a PET-scan study comparison with other methods

The authors studied muscular blood flow (F), oxygen consumption rate (R), and oxygen extraction fraction (E) in 5 patients suffering from severe intermittent claudication (stage II). They applied the bolus technique of H2150 and 1502 with a detection by positron emission tomography (PET). Tomograms were recorded at the greatest diameter of the calves, at rest and ten minutes after a treadmill walk test leading to the development of ischemic pain in the affected extremity. F and E data were compared with the values obtained by more usual methods, namely occlusive venous strain gauge plethysmography and femoral venous blood sampling. During the study, these patients received naftidrofuryl, a vasodilatator drug, in an intravenous dose of 600 mg diluted in 250 mL saline infused over a six-hour period in a placebo-controlled, double-blind, crossover protocol (two consecutive experiments, a week apart). The results showed that all blood flow values measured at rest and after exercise by PET were in close correlation (r = 0.71) with the plethysmographic findings. The agreement between the two methods of measuring blood flow was less obvious with an Altman's presentation of the data: there was a tendency to measure higher values with PET scan. Concerning E, the correlation was poor at rest. After exercise, the values were more elevated with PET and no correlation was found with blood samples. The authors found no significant effect of naftidrofuryl either on flow or metabolic data