A Comparison of the Effects of Electrical Calf Muscle Stimulation and the Venous Foot Pump on Venous Blood Flow in the Lower Leg

Laverick, M. D.; McGivern, R. C.; Crone, M.; Mollan, R. A. B.

doi:10.1177/026835559000500411

Cited by 32 publications

(14 citation statements)

References 7 publications

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“…Several previous studies have suggested that electrical stimulation-induced rhythmic muscle contractions can activate the skeletal muscle pump (14,15). In our present study, we also observed that Neiguan EA caused visible rhythmic local muscle contractions.…”

Section: Muscle Pump Contributionsupporting

confidence: 86%

“…We began experiments and recorded the hemodynamic parameters at baseline and during hypotension (15,30,50,70, and 90 min after hemorrhage) in the control and experimental dog groups (see below). During the initial 30 min after hemorrhage as a control period of hemorrhagic hypotension, neither treatment nor stimulation was given to dogs in either control or Neiguan EA groups.…”

Section: Experimental Protocolsmentioning

confidence: 99%

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Pressor effect of electroacupuncture on hemorrhagic hypotension

Syuu

Matsubara

Hosogi³

et al. 2003

American Journal of Physiology-Regulatory, Integrative and Comp

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Neiguan (PC-6) is a traditional acupoint in each forearm and overlies the trunk of the median nerve. Previous studies show that electroacupuncture (EA) at the Neiguan acupoint could improve not only myocardial ischemic dysfunction by inducing a depressor response but also recover hemorrhagic hypotension by inducing a pressor response. However, their physiological mechanisms are not yet elucidated. We investigated the pressor effect of Neiguan EA and its mechanism by focusing on left ventricular (LV) performance in a canine hemorrhagic hypotension model. We hemorrhaged 36 anesthetized and thoracotomized mongrel dogs and decreased LV end-systolic pressure (ESP) to approximately 70 mmHg (35% decrease). We obtained LV pressure-volume (P-V) data with a micromanometer catheter and a conductance catheter. One-hour Neiguan EA significantly recovered the decreased ESP, end-diastolic volume, and stroke volume by 32 +/- 13%, 27 +/- 13%, and 39 +/- 17%, respectively (P < 0.05), without changing heart rate and the slope of the end-systolic P-V relation. Neiguan EA inhibited a hemorrhage-induced increase in plasma catecholamines. However, vecuronium (neuromuscular blocking agent) administration abolished the antihypotension effect of Neiguan EA. Furthermore, Neiguan EA was much more effective than a nonacupoint thigh EA. We conclude that Neiguan EA achieved the antihypotension effect by improving LV filling of the hemorrhage-depressed LV performance despite the inhibition of the hemorrhage-increased plasma catecholamines. This pressor effect seemed to accompany an increased venous return by Neiguan EA-increased vasomotor tone and muscle pump. This study demonstrated a scientific basis for the therapeutic efficacy of acupuncture in the treatment of hemorrhagic hypotension and shock.

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Section: Muscle Pump Contributionsupporting

confidence: 86%

Section: Experimental Protocolsmentioning

confidence: 99%

Pressor effect of electroacupuncture on hemorrhagic hypotension

Syuu

Matsubara

Hosogi³

et al. 2003

American Journal of Physiology-Regulatory, Integrative and Comp

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“…More data and further study is required to support this observation. However this observation was also made by Faghri et al (1997) and Laverick et al (1990) as being a feature of NMES-elicited enhanced venous blood flow. The aim of both IPC and NMES in the prevention of DVT is to prevent venous stasis.…”

Section: Discussionmentioning

confidence: 55%

Comparative lower limb hemodynamics using neuromuscular electrical stimulation (NMES) versus intermittent pneumatic compression (IPC)

et al. 2014

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Deep Vein Thrombosis (DVT) is a life threatening condition and a serious concern among hospitalised patients, with death occurring in approximately 6% of cases. Intermittent pneumatic compression (IPC) is commonly used for DVT prevention, however suffers from low compliance and issues of usability and portability. Neuromuscular electrical stimulation (NMES) has been shown to improve lower limb hemodynamics but direct comparison with IPC in terms of hemodynamics is rare but very important to determine the potential effectiveness of NMES in DVT prevention.Lower limb IPC was compared to calf NMES, in 30 healthy volunteers (18-23 years). Each intervention was carried out on each leg, on the popliteal vein measured using Doppler ultrasound. All interventions produced significantly greater haemodynamic responses compared to baseline. Calf-IPC and NMES produced significant increases in venous blood velocity (cm/s) and volume of blood ejected per cycle (1 cycle of NMES expels 23.22 ml compared to the baseline ejected volume of 2.52 ml, measured over 1 s (p < 0.001 versues baseline).Improving lower limb hemodynamics is vital in preventing DVT. NMES resulted in larger ejected volumes compared to IPC (x3 greater than foot-IPC and x1.7 greater than calf-IPC) more effectively emptying the veins and soleal sinuses. This is an important finding as DVT occurs predominantly in the soleal sinuses. NMES is silent and portable and thus does not suffer many of the issues associated with IPC. This work supports the potential widespread application of NMES in hospital and home settings where the risk of DVT formation is high.

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“…Most DVTs have been shown to arise in these gastrosoleal plexuses and many mechanical methods have been designed which aim to promote venous return by promoting the role of the redundant muscle pumps. 21 One of the most popular methods is the A-V impulse system which was based on the discovery of the mechanism of the venous pump in the sole of the human foot. 22 Subsequent work showed that venous return could be improved by flattening of the plantar arch causing lengthening of the venae commitantes of the lateral plantar arch, which was independent of muscular activity.…”

Section: Discussionmentioning

confidence: 99%

The relationship of foot and ankle movements to venous return in the lower limb

Sochart

Hardinge

1999

The Journal of Bone and Joint Surgery. British volume

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W e have studied the relationship between movements of the foot and ankle and venous blood flow from the lower limb using colourflow Duplex ultrasound to determine the optimum type of exercise for promoting venous return. Studies of both active and passive movements were carried out on 40 limbs in 20 subjects (18 men; 2 women), with a median age of 27 years (20 to 54). We assessed ankle dorsiflexion and plantar flexion, subtalar inversion and eversion, and a combination of all movements. There was no difference in venous flow when comparing opposite limbs in a single subject (p > 0.5), but active exercises produced higher peak and mean velocities of blood flow than passive ones. The active combined movement produced the highest velocities with an increase of 38% in mean and of 58% in peak flow velocities, which were significantly greater than the peak and mean flow rates produced by passive movements. The active combined exercise would therefore be the most effective in eliminating stasis and could contribute to the prevention of deep-vein thrombosis.

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A Comparison of the Effects of Electrical Calf Muscle Stimulation and the Venous Foot Pump on Venous Blood Flow in the Lower Leg

Cited by 32 publications

References 7 publications

Pressor effect of electroacupuncture on hemorrhagic hypotension

Pressor effect of electroacupuncture on hemorrhagic hypotension

Comparative lower limb hemodynamics using neuromuscular electrical stimulation (NMES) versus intermittent pneumatic compression (IPC)

The relationship of foot and ankle movements to venous return in the lower limb

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