Pulsatile venous Doppler flow in lower limbs: highly indicative of elevated right atrium pressure.

Abu‐Yousef, Monzer M.; Kakish, M E; Mufid, M

doi:10.2214/ajr.167.4.8819397

Cited by 62 publications

(54 citation statements)

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“…As shown in Figs. 4 and 5, we consistently observed the propagation of venous waves as far as the femoral veins, and the same phenomenon also has been observed in human lower limbs (1,23).…”

Section: Discussionsupporting

confidence: 85%

Systemic venous circulation. Waves propagating on a windkessel: relation of arterial and venous windkessels to systemic vascular resistance

Wang¹,

Flewitt²,

Shrive³

et al. 2006

American Journal of Physiology-Heart and Circulatory Physiology

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. Systemic venous circulation. Waves propagating on a windkessel: relation of arterial and venous windkessels to systemic vascular resistance. Am J Physiol Heart Circ Physiol 290: H154 -H162, 2006. First published August 19, 2005 doi:10.1152/ajpheart.00494.2005.-Compared with arterial hemodynamics, there has been relatively little study of venous hemodynamics. We propose that the venous system behaves just like the arterial system: waves propagate on a time-varying reservoir, the windkessel, which functions as the reverse of the arterial windkessel. During later diastole, pressure increases exponentially to approach an asymptotic value as inflow continues in the absence of outflow. Our study in eight open-chest dogs showed that windkessel-related arterial resistance was ϳ62% of total systemic vascular resistance, whereas windkesselrelated venous resistance was only ϳ7%. Total venous compliance was found to be 21 times larger than arterial compliance (n ϭ 3). Inferior vena caval compliance (0.32 Ϯ 0.015 ml ⅐ mmHg Ϫ1 ⅐ kg Ϫ1 ; mean Ϯ SE) was ϳ14 times the aortic compliance (0.023 Ϯ 0.002 ml ⅐ mmHg Ϫ1 ⅐ kg Ϫ1 ; n ϭ 8). Despite greater venous compliance, the variation in venous windkessel volume (i.e., compliance ϫ windkessel pulse pressure; 7.8 Ϯ 1.1 ml) was only ϳ32% of the variation in aortic windkessel volume (24.3 Ϯ 2.9 ml) because of the larger arterial pressure variation. In addition, and contrary to previous understanding, waves generated by the right heart propagated upstream as far as the femoral vein, but excellent proportionality between the excess pressure and venous outflow suggests that no reflected waves returned to the right atrium. Thus the venous windkessel model not only successfully accounts for variations in the venous pressure and flow waveforms but also, in combination with the arterial windkessel, provides a coherent view of the systemic circulation. systemic circulation SIGNIFICANT EFFORTS have been devoted to the understanding of arterial hemodynamics, but much less attention has been paid to the venous systems (3, 24). The application of frequencydomain impedance analysis to venous pressure and flow seemed less successful than to arterial pressure and flow because the apparent reflection site was difficult to explain physiologically (27,32). Brecher studied venous hemodynamics, and Sjostrand suggested that the cavae constituted a "surge chamber," which Rushmer termed a "preventricular sump." Noordergraaf (24) concluded that "no analytical treatment of the pressure-flow relationship in relation to. . .cardiac activity has been proposed. As a consequence, Brecher's suggestion that the central veins constitute the functional counterpart of the arterial reservoir, transforming steady flow into pulsatile flow, has not received the scientific scrutiny that such an intuitively appealing idea deserves." Thus we have endeavored to develop a new model in an attempt to follow Brecher's suggestion and to understand venous hemodynamics better.In 1992, Tyberg (33) proposed a steady-state hydraulic mod...

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Section: Discussionsupporting

confidence: 85%

Systemic venous circulation. Waves propagating on a windkessel: relation of arterial and venous windkessels to systemic vascular resistance

Wang¹,

Flewitt²,

Shrive³

et al. 2006

American Journal of Physiology-Heart and Circulatory Physiology

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“…5 Nonetheless, our results, even though they show a significant inverse relation between the appearance of the pulsatile wave and the increase in CVP, which confirms the hypothesis stated by Abu-Yousef and coauthors, do not establish a relationship with heart disease.…”

supporting

confidence: 85%

“…5 They obtained a sensitivity of 46%, a specificity of 94%, a PPV of 94%, and an NPV of 50%. This study had errors in method since the measuring angle of the venous wave was not adequate, and no measures were taken of the velocities to quantify the alteration in the venous wave.…”

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confidence: 96%

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Correlation of central venous pressure with Doppler waveform of the common femoral veins.

Cozcolluela

Sarría

Sanz

et al. 2000

Journal of Ultrasound in Medicine

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The objects of this prospective study were to determine the nature of the flow in the right femoral vein and to correlate the flow velocity with the venous pressure measured in the right atrium. We performed 236 pulsed Doppler ultrasonographic examinations in 1 year on patients with a venous catheter with the distal tip in the right atrium. In the Doppler wave readouts we analyzed wave frequency, velocity components, and relationships among them and the existence of pulsatile flow. These parameters were then compared to the right atrium pressure. We investigated the correlation between the atrium pressure and the flow velocity obtained from the Doppler waveforms of the common femoral veins, obtaining a significant correlation (P<0.0001) with the following: the atrium systolic wave a, the atrium diastolic wave v, the pulsatility ratio (PR = Vmin/Vmax) and the pulsatility index (PI = [Vmax ‐ Vmin] /Vavg). The receiver operating characteristic showed that the pulsed Doppler ultrasonography is not a sensitive technique in diagnosis high atrium pressures. In addition, both cardiac and respiratory phasicity of the venous wave was observed. A significant inverse relation was found between the pulsatile flow and high atrium pressure. Nonetheless, the low sensitivity of this technique does not allow the use of pulsatile Doppler ultrasonography in the common femoral vein for diagnosing increases of the atrium pressure.

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“…7 Raised right atrial pressure of more than 8 mmHg has been recorded in right heart failure, correlating with pulsatile lower limb venous Doppler waveforms. 2 Even though there has been a correlation between right heart failure and pulsating varicose veins, the literature is not clear whether right heart failure is an etiological factor in octogenarian patients with recent-onset venous insufficiency and venous ulcers. As pulsating varicose veins can be deceptive to the unsuspecting mind, the more common diagnosis of arteriovenous malformation is suspected and can lead to surgical exploration without considering a diagnosis of heart failure.…”

Section: Discussionmentioning

confidence: 99%

Sonographic Evaluation of Chronic Venous Insufficiency in Right Heart Failure

Abbas

Yahya

Hamilton

et al. 2005

Journal of Diagnostic Medical Sonography

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Clinical and sonographic findings of three octogenarian patients with recent-onset venous insufficiency with venous ulcer were evaluated with clinical examination and venous duplex scanning. The venous duplex findings in the affected lower limb of patients with right heart failure showed phasic flow in the long saphenous vein. The phasic flow was traced back up to the inferior vena cava and the hepatic veins. Echocardiogram confirmed marked tricuspid regurgitation. Clinically, a simple compression of the sapheno-femoral junction showed an absence of pulsation in the long saphenous veins, giving clinical confirmation that venous backflow caused the pulsation in the limb veins. Right heart failure in patients with late-onset venous insufficiency and venous ulcer should be suspected. Sonography complemented with clinical examination is the key to the proper evaluation and management of chronic venous insufficiency with right heart failure.

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Pulsatile venous Doppler flow in lower limbs: highly indicative of elevated right atrium pressure.

Cited by 62 publications

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Systemic venous circulation. Waves propagating on a windkessel: relation of arterial and venous windkessels to systemic vascular resistance

Systemic venous circulation. Waves propagating on a windkessel: relation of arterial and venous windkessels to systemic vascular resistance

Correlation of central venous pressure with Doppler waveform of the common femoral veins.

Sonographic Evaluation of Chronic Venous Insufficiency in Right Heart Failure

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