Improvement of Ambulatory Venous Hypertension by Narrowing of the Femoral Vein in Congenital Absence of Venous Valves

Abstract

Objective: To assess the effect of femoral vein compression in a patient with congenital avalvulae. Design: Single patient study. Setting: Department of Dermatology; Teaching Hospital, Vienna, Austria. Patient: A single patient with the rare condition of congenital absence of venous valves. Interventions: Compression of the thigh using a thigh Main outcome measures: Ambulatory venous pressure Measurement. Results: The ambulatory venous pressure was reduced when the thigh calf pressure was increased in excess of 70 mmHg. Conclusion: Thigh compression in a patient with congenital absence of venous valves resulted in a temporary valve mechanism permitting orthograde flow during muscle systole, but inhibiting venous reflux.

Inelastic Leg Compression Is More Effective to Reduce Deep Venous Refluxes than Elastic Bandages

“…However, the results are dependent on the speed in which the patients can move from supine to standing position. 3 To evaluate the amount of compressions the authors used the interface pressure measurement (Oxford pressure monitor MKII), which is we feel, a good instrument to determine the amount of pressure of bandages. By using this technique, an important variation, namely how to apply a consistent pressure with the bandage, can be standardized.…”

“… 2 Such narrowing impedes deep venous refluxes even in the absence of any valves and leads to a reduction of ambulatory venous hypertension in the acute experiment. 3 …”

Do we still need compression bandages? Haemodynamic effects of compression stockings and bandages

“…In such patients who develop severe skin changes on the distal lower leg and venous ulcers at an early age, we have measured the intravenous pressure on the dorsum of the foot. 19 During walking on a treadmill, no pressure fall was observed, but a blood pressure cuff with 80 mmHg on the thigh led to a distinct reduction of ambulatory venous hypertension, most likely due to an intermittent interruption of venous reflux. Lower degrees of external pressure did not improve ambulatory venous hypertension.…”

Relevance of stiffness of compression material on venous hemodynamics and edema

“…In particular compression has been proven effective in reducing venous volume, reflux, venous pumping function, edema and, consequently, ambulatory venous hypertension. [2][3][4][5][6][7][8] Compression may be applied to the leg by different materials: elastic stockings, elastic and inelastic bandages, and/or velcro-banddevices. The main differences between these materials are the exerted pressure and the elastic properties which can influence their hemodynamic effects.…”

“…15,16 Similar vein narrowing may occur while walking with inelastic materials that produces pressure peaks which overcome the intravenous pressure with every step and leads to an intermittent narrowing of the veins 15 thus restoring a kind of artificial valve mechanism. 17 Elastic material or elastic stockings cannot achieve similar results because in order for the compression to be tolerable the exerted pressure range can never exceed 50 mmHg. This degree of compression can slightly influence the venous diameter but certainly cannot produce significant vein narrowing.…”