Impeded venous drainage: Novel view of chronic venous disease pathophysiology

Gaweesh, Ahmed S.

doi:10.1016/j.mehy.2009.05.046

Cited by 9 publications

(11 citation statements)

References 28 publications

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“…The calf muscles, and possibly the thigh muscles, act as a pump, also called as "peripheral heart", which can generate pressures of up to 300 mm Hg during exercise [86]. Nevertheless, it has been suggested that thigh muscle pump has a minor effect in venous return, compared to calf muscle pump [43,57,84].…”

Section: Thigh Muscle Pumpmentioning

confidence: 99%

Manual Lymphatic Drainage in the Treatment of Chronic Venous Disease

Crisóstomo¹,

Armada-da-Silva²

2017

Clinical Physical Therapy

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Chronic venous disease (CVD) is a chronic condition that is associated with venous hypertension, vein's valves damage, venous obstruction, and calf muscle pump impairment. This blood circulatory condition is also characterized by important inflammatory changes affecting the skin, the subcutaneous tissue and the muscles, which are probably triggered by blood stasis and venous edema. With disease progression, severe ulcerative skin damage might occur, which when present represent the more severe stage of this condition. CVD has a significant economic, social and health impact, mostly due to raised morbidity and chronicity.The treatment of patients with CVD might focus on both the symptoms and secondary changes of the disease, such as edema, skin and subcutaneous changes or ulcers.Usually, initial treatment of CVD patients involves a non-invasive, conservative treatment to reduce symptoms, treat secondary changes, and help prevent the development of secondary complications and the progression of the disease. Complementary, some interventional or surgical treatments can be undertaken.There are several conservative treatments to treat and prevent complications associated with CVD that have been described in the literature, like manual lymphatic drainage (MLD) and compression, physical exercise, intermittent pneumatic pressure, kinesio taping, electrical muscle stimulation, transcutaneous electrical nerve stimulation, hydrotherapy, and health education. Most of these techniques are complementary to compression therapy or pharmacological treatment. This chapter will address the role of physical therapists in the management of CVD. The chapter will begin by reviewing the basic physiopathology of CVD, including the role of calf muscle pump. The CEAP classification system and the chronic venous severity score will be presented, as these are main tools for clinical assessment of CVD severity. In the remainder of the chapter will address the physiological effects and recommendations for treating CVD of MLD, based on our clinical experience and own research.

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Section: Thigh Muscle Pumpmentioning

confidence: 99%

Manual Lymphatic Drainage in the Treatment of Chronic Venous Disease

Crisóstomo¹,

Armada-da-Silva²

2017

Clinical Physical Therapy

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“…Chronic venous hypertension increases the capillaries permeability allowing fluid, proteins, and blood cells to leak into the tissues. Ulceration is precipitated by reduced oxygen diffusion to the skin and microvasculature damages that are associated with edema [1,13]. These changes are caused by:…”

Section: Venous Stasis Ulcersmentioning

confidence: 99%

“…Older people are prone to developing calf muscle failure due to muscle wasting, neuropathy, immobility, and/or limited ankle mobility [12,13]. 2.…”

Section: Management Of Venous Disease-key Points Specific To the Eldementioning

confidence: 99%

“…3. Rule out and correct (when possible) other causes of edema frequently found in the elderly population, such as congestive heart failure, hypoalbuminemia (indicating liver or kidney disease), deep vein thrombosis (DVT), or cellulitis due to alterations in microvascular pressure, protein concentration or barrier permeability [12,13]. 4.…”

Section: Management Of Venous Disease-key Points Specific To the Eldementioning

confidence: 99%

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Management of Venous Stasis Ulcers in the Older Adult

Woo

LeBlanc

Livingston³

2015

Curr Geri Rep

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Venous stasis disease is common among older adults due to calf muscle pump failure, immobility, chronic edema, and obesity. Increased venous pressure increases the capillaries' permeability allowing fluid, proteins, and blood cells to leak into the tissues. Ulceration is precipitated by reduced oxygen diffusion to the skin and microvasculature damages. While most chronic leg ulcers are caused by venous stasis disease, there is a need to rule out other underlying pathologies including arterial, neuropathic, metabolic, hematological, infectious, malignant, and inflammatory diseases. Compression therapy with high stiffness index is the mainstay of treatment for venous leg ulcers. Adherence to compression therapy could be a challenge in the older population due to reduced dexterity, muscle strength, range of motion, and flexibility. Medications such as pentoxifylline, flavonoids, and zinc have been shown to have a positive role in the management of venous disease.

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“…Es wird als leicht durchzuführender Eingriff mit wenig Nebenwirkungen dargestellt und verspricht schnelle Linderung von Stauungsbeschwerden. Es wurde sogar als Therapieoption für Patienten mit großlumigen Krampfadern angeboten [1] und mit dieser Option sogar in Werbebroschüren von einigen Praxen, auch in Deutschland, dem Patienten angeboten. Allerdings konnte kein Zusammenhang zwischen großlumigen Varizen und einer Iliakalvenen-Obstruktion bei Patienten ohne Thrombose-Vorgeschichte nachgewiesen werden [2].…”

Section: Introductionunclassified

Welches ist der Stellenwert der Luft-Plethysmographie zur Diagnostik der Iliakal-Venen-Obstruktion?

Mendoza¹,

Lattimer

2019

Phlebologie

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ZusammenfassungDurch die Möglichkeit der Stenteinlage in iliakale Venen scheint die Behandlung der zentralen Obstruktion ein leichtes Unterfangen geworden zu sein. Allerdings bedingt diese Behandlung eine zumindest vorübergehende Antikoagulation – und der Stent wird lebenslang im Bein verbleiben. Und die Evaluation der Ergebnisse ist noch nicht gut etabliert. Auch die Indikationsstellung ist nicht immer objektivierbar gegeben, wenn man bedenkt, dass 25 % der Bevölkerung eine Stenose der linken V. iliaca von über 50 % aufweisen, auch wenn sie meist keine Symptome haben. Erschwerend kommt hinzu, dass die venöse chronische Insuffizienz als klinisches Syndrom (CVI) mehrere Ursachen haben kann, wie Varikose, Obstruktion oder Refluxe der tiefen Achse und die Behandlung eines einzelnen, anatomischen Befundes nicht unbedingt die Klinik nachhaltig verbessern muss. Die Luft-Plethysmographie (Air Plethysmography, APG) bietet in diesem Zusammenhang eine objektive, vom Untersucher und vom Patienten unabhängige Auswertungsmöglichkeit für die venöse Drainage und für die venöse Wiederauffüllzeit, die in jedem Fall vor einem Eingriff der zentralen Venen und zur Evaluation des Ergebnisses gefordert werden sollte.

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Impeded venous drainage: Novel view of chronic venous disease pathophysiology

Cited by 9 publications

References 28 publications

Manual Lymphatic Drainage in the Treatment of Chronic Venous Disease

Manual Lymphatic Drainage in the Treatment of Chronic Venous Disease

Management of Venous Stasis Ulcers in the Older Adult

Welches ist der Stellenwert der Luft-Plethysmographie zur Diagnostik der Iliakal-Venen-Obstruktion?

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