Calf muscle pump pressure-flow cycle during ambulation

Tauraginskii, Roman A.; Lurie, Fedor; Simakov, Sergey; Agalarov, Rishal; Борсук, Д. А.; Khramtsov, Pavel

doi:10.1016/j.jvsv.2023.04.002

Cited by 3 publications

(7 citation statements)

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“…It produces low or even negative pressure in the intramuscular veins of the GCM. 34 Arterial flow to the working muscles occurs during their relaxation. 40,41 However, hypothetically, during muscle relaxation corresponding to the swing phase of the stride cycle, the intramuscular venous network should be filled with blood from the venous network located outside the muscle fascial sheath as well.…”

Section: Discussionmentioning

confidence: 99%

“…The methods used were thoroughly described in the previous work. 34 The study conformed to the Declaration of Helsinki. The local ethics committee of Surgut State University approved the study (protocol #22 of 02.17.2021).…”

Section: Methodsmentioning

confidence: 99%

“…The same sample of nine healthy volunteers (seven men and two women) was enrolled in the study. 34 None had clinical or ultrasound signs of CVD, impaired joint mobility, or artery lesions of the lower extremities. The participants were carefully informed of the study protocol and provided written consent to participate in the study.…”

Section: Methodsmentioning

confidence: 99%

“…The intramuscular vein approaching for catheterization was connected to the superficial venous system via a perforating vein (PV) with size and anatomy allowing for catheterization without muscle damage. 34 The intramuscular catheter was adjusted to the level of the GSV CALF catheter. All catheterization points are presented in Figure 1a .…”

Section: Methodsmentioning

confidence: 99%

“…18,19 However, a recent study assessing CMP work during actual ambulation has shown that the muscle pump function differs from artificial maneuvers in the functional tests. 34 First, the VS acts as a conduit rather than a reservoir. It transfers blood from the network of intramuscular veins to the axial deep veins.…”

Section: Introductionmentioning

confidence: 99%

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Human lower leg muscle pump acts like a stream diversion pump during locomotion

Tauraginskii,

Lurie,

Simakov

et al. 2023

Preprint

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BackgroundCalf muscle pump (CMP) failure is associated with the development and progression of chronic venous insufficiency as characterized by ambulatory venous hypertension (AVH). However, the explicit interconnection between AVH with CMP failure remains uncertain because the concept of CMP function is controversial. The study aimed to measure pressure in different segments of the great saphenous vein (GSV) and intramuscular vein of the gastrocnemius (GCM) during exercise.MethodsTwelve legs of nine healthy volunteers were enrolled in the study. Continuous pressure (IVCALF, GSV at ankle, proximal calf, and mid-distal thigh) and electromyography data (GCM and anterior tibial muscle [ATM]) were recorded during treadmill walking, running, and plantar flexion exercises. The pressure gradient (PG, mmHg) between adjacent points of measurement was calculated. Minute unit power of muscle pump ejection and suction (, and, MPa/min) were calculated and compared with the arterial blood supply of the lower extremity (LBF, L/min).ResultsPG demonstrated a consistent pattern of changes during walking and running. An absence of PG directed from the calf to the thigh (centripetal) in the GSV was observed. Instead, a retrograde PG was verified throughout the entire stride cycle. Its value decreased with the increase in stride cycle frequency. The dynamics of PG between the IV and GSV were the following: It was directed from the IV to GSV during GCM contraction and was reversed during ATM contraction and GCM relaxation (swing phase). LBF,, anddemonstrated similar exponential growth with the increase in stride frequency during walking and running.ConclusionsThe pressure gradient in the GSV prevents centripetal flow during locomotion. Instead, PG directs blood flow from the GSV toward intramuscular veins. The increase in CMP unit power was tightly coupled with lower extremity arterial blood supply growth that prevented ambulatory venous pressure rise during exercise.Novelty and Significance What Is Known?The existence of a pressure gradient in superficial veins directed centripetally (from calf to thigh level) has been confirmed for the state of rest only (lying and standing).The existence of a pressure gradient directed from intramuscular to superficial veins or vice versa has been confirmed for the artificial exercise tests only (tiptoe movements, walking in place etc.).The main calf muscle pump function was considered as its ability to eject blood centripetally by posterior calf muscle group contraction.What New Information Does This Article Contribute?An absence of pressure gradient directed from the calf to the thigh (centripetal) in the great the saphenous vein during locomotion.During locomotion, at the lower leg level, the primary route of blood outflow from the superficial veinous network toward intramuscular veins is a horizontal route (through perforating veins).New parameters are introduced to assess calf muscle pump effectiveness as its ability to maintain accordance between the muscle pump output and arterial blood supply during locomotion.The calf muscle pump (CMP) is known as a significant contributor to venous blood outflow from the lower extremity due to its ability to effectively eject blood in a centripetal direction. Therefore, CMP failure refers to an impaired ejecting ability associated with chronic venous insufficiency (CVI) occurrence and progression. It is expressed in the increase in ambulatory venous pressure referred to as ambulatory venous hypertension (AVH). However, multiple studies demonstrated a lack of agreement between defined CMP failure and AVH, the severity of CVI, and quality of life.Here we show that during locomotion, the CMP acts as a stream diversion pump redirecting blood flow from superficial veins (SVs) to intramuscular veins (IVs) through perforating veins. This is because the observed pressure gradient prevents centripetal blood flow from the calf to thigh level in the SVs and favors blood flow from SVs to IVs during the swing phase of the stride cycle. This function is provided by the synergetic work of antagonist calf muscles (anterior tibial muscle and gastrocnemius). Thereby, the CMP prevents pressure growth in the superficial veins of the lower leg (AVH) during exercise when the arterial blood supply increases according to exercise intensity.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Human lower leg muscle pump acts like a stream diversion pump during locomotion

Tauraginskii,

Lurie,

Simakov

et al. 2023

Preprint

Self Cite

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The Principle of Limb Reconstruction—“One Walking, Two Lines, and Three Balances”: A Retrospective Analysis of Post‐Traumatic Lower Limb Deformity Correction

Zang,

Wei,

Shi

et al. 2024

Orthopaedic Surgery

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ObjectiveThe principles of limb reconstruction are crucial for treatment success, but there is no unified standard for complex limb deformities. The aim of this study was to analyze the characteristics of the cases of post‐traumatic lower limb deformity and explore the new principle of limb reconstruction.MethodA retrospective analysis was conducted of 148 patients with post‐traumatic lower limb deformity who underwent surgery from May 1978 to December 2023; 85 were males (57.4%) and 63 were females (42.6%); 65 cases of left side (43.9%), 79 cases of right side(53.4%), and 4 cases were on both sides (2.7%), the average age was 24.64 years (5–69). There were 4 cases suffering hip deformities, 40 cases of femoral deformities, 18 cases from knee, 40 cases from tibiofibular, 93 cases of foot and ankle deformities, and some patients also had two or more types. All patients underwent surgical intervention in an average of 40.5 months (12–96) after injury. According to the evaluation of limb deformities, deformity correction and functional reconstruction with external fixation were implemented, following the principle of “one walking, two lines, and three balances.” The clinical evaluation adopts the criteria of Qinsihe lower limb deformity correction and functional reconstruction.Result148 patients with post‐traumatic lower limb deformities were followed up for 40.9 (12–356) months. The main surgical procedures implemented were tendon lengthening and soft tissue release (84 cases), osteotomy (93 cases), joint fusion (30 cases), and tendon transposition (16 cases); there were multiple surgical procedures in some patients. Among them, 124 cases used external fixators for stress control and 27 cases used internal fixation, while 3 cases used plaster or brace. There were 5 wire reactions postoperatively, which improved after dressing change and oral antibiotics. There were 2 pin infections, which improved by pin removing. No surgical related deep infections occurred, and no surgical related neurovascular damage occurred. At the last follow‐up, all limb deformities were corrected, limb function improved, and the results of treatment was very satisfactory. According to Qinsihe evaluation criteria for lower limb deformities, 74 cases were excellent, 56 cases good, and 18 cases fair, with an excellent and good rate of 87.84%.ConclusionStress control with external fixation is effective, safe, and controllable in correcting and reconstructing post‐traumatic lower limb deformities. The principle of “one walking, two lines, and three balances” plays an important role in the entire process of stress control limb reconstruction.

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Development of a New Adjustable Compression Garment (McBoooon) Made of Non-Stretch Self-Adhesive Fabric

Shiraishi,

Kinoto,

Miyoshi

et al. 2024

Annals of Vascular Diseases

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Objectives: To assess the physical features and compression characteristics of a newly developed adjustable compression garment, McBoooon (Mc). Methods: Twelve healthy volunteers were recruited to assess the compression characteristics. The interface pressure (IP) was continuously measured to calculate the static (SSI) and dynamic stiffness indices (DSI). Additionally, the peak flow velocity (PV) of the popliteal vein during ankle dorsiflexion was measured using ultrasonography. Each parameter was compared between ASHIKA stockings (AS), Mc applied at the same resting pressure as AS (Mc1), and Mc applied at a resting pressure approximately twice that of Mc1 (Mc2). Results: SSI and DSI were significantly different, increasing in the order AS < Mc1 < Mc2 (p <0.01). Although the PV was significantly higher in the compression group than in the control group (p <0.05), no significant differences were found among the three groups. Conclusion: The physical features and compression characteristics of Mc were clarified. The high stiffness of this garment improves the adherence to compression therapy and contributes to the treatment of chronic venous insufficiency.

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Calf muscle pump pressure-flow cycle during ambulation

Cited by 3 publications

References 38 publications

Human lower leg muscle pump acts like a stream diversion pump during locomotion

Human lower leg muscle pump acts like a stream diversion pump during locomotion

The Principle of Limb Reconstruction—“One Walking, Two Lines, and Three Balances”: A Retrospective Analysis of Post‐Traumatic Lower Limb Deformity Correction

Development of a New Adjustable Compression Garment (McBoooon) Made of Non-Stretch Self-Adhesive Fabric

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