Relationship Between Venous Pressure and tissue Volume During Venous Congestion Plethysmography in Man

Christ, F.; Gamble, J.; Baschnegger, Heiko; Gartside, I B

doi:10.1111/j.1469-7793.1997.463bh.x

Cited by 143 publications

(65 citation statements)

References 13 publications

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“…To convert to units of millimeters Hg, the height difference was multiplied by a factor 0.766, which includes a correction for the specific gravity of blood (ϭ1.055) (4,5,22). The determination of the hydrostatic column was done in duplicate, with a coefficient of variation Ͻ4%.…”

Section: Subjectsmentioning

confidence: 99%

Leg intravenous pressure during head-up tilt

Groothuis

Poelkens²,

Wouters³

et al. 2008

Journal of Applied Physiology

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Groothuis JT, Poelkens F, Wouters CW, Kooijman M, Hopman MT. Leg intravenous pressure during head-up tilt. J Appl Physiol 105: 811-815, 2008. First published July 17, 2008 doi:10.1152/japplphysiol.90304.2008.-Leg vascular resistance is calculated as the arterial-venous pressure gradient divided by blood flow. During orthostatic challenges it is assumed that the hydrostatic pressure contributes equally to leg arterial, as well as to leg venous pressure. Because of venous valves, one may question whether, during orthostatic challenges, a continuous hydrostatic column is formed and if leg venous pressure is equal to the hydrostatic pressure. The purpose of this study was, therefore, to measure intravenous pressure in the great saphenous vein of 12 healthy individuals during 30°and 70°h ead-up tilt and compare this with the calculated hydrostatic pressure. The height difference between the heart and the right medial malleolus level represented the hydrostatic column. The results demonstrate that there were no differences between the measured intravenous pressure and the calculated hydrostatic pressure during 30°(47.2 Ϯ 1.0 and 46.9 Ϯ 1.5 mmHg, respectively) and 70°head-up tilt (83.9 Ϯ 0.9 and 85.1 Ϯ 1.2 mmHg, respectively). Steady-state levels of intravenous pressure were reached after 95 Ϯ 12 s during 30°and 161 Ϯ 15 s during 70°head-up tilt. In conclusion, the measured leg venous pressure is similar to the calculated hydrostatic pressure during orthostatic challenges. Therefore, the assumption that hydrostatic pressure contributes equally to leg arterial as well as to leg venous pressure during orthostatic challenges can be made.venous pressure; hydrostatic pressure; leg vascular resistance THE INCREASE in leg vascular resistance, by a baroreflex-induced increase in sympathetic tone and by local mechanisms such as the venoarteriolar axon "reflex" (VAR) (10) and the myogenic response (12), are important to withstand orthostatic challenges (19). Peripheral vascular responses to orthostatic challenges, quantified by leg vascular resistance, have been studied in healthy individuals as well as in individuals with autonomic dysfunction (5, 7-9, 12-15, 20 -23).In supine position, leg vascular resistance is calculated as the arterial-venous pressure gradient (P a Ϫ P v ) divided by blood flow. In supine position, most studies (7-9, 12, 13, 15) assume that venous pressure equals 0 mmHg and use mean arterial blood pressure (MAP) to replace the arterial-venous pressure gradient, while others (5, 20 -23) have estimated venous pressure in the leg using venous occlusion plethysmography. During orthostatic challenges a hydrostatic pressure is added to leg arterial as well as to leg venous pressure due to gravitational translocation of blood (19,24). One may question how upright posture will affect the arterial-venous pressure gradient. The veins have valves that close at the onset of orthostatic challenges and thereby interrupt the development of a continuous hydrostatic column. When an orthostatic challenge persists, the veins...

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Section: Subjectsmentioning

confidence: 99%

Leg intravenous pressure during head-up tilt

Groothuis

Poelkens²,

Wouters³

et al. 2008

Journal of Applied Physiology

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show abstract

“…It enables a sensitive recording of limb circumference during venous congestion and an off-line computer-assisted calculation of microcirculatory parameters [16]. Filtrass enables to measures three macrovascular parameters: Q a (ml·min –1 ·100 ml tissue –1 ), which is the local arterial blood flow into the limb, P v (mm Hg), the ambient local venous pressure and C (ml·mm Hg –1 ·10 –2 ), the vascular compliance [14]. Two microvascular parameters, the capillary filtration capacity (CFC) (ml·min –1 ·100 ml –1 ·mm Hg –1 ) and the isovolumetric venous pressure (P vi ; mm Hg), were also calculated.…”

Section: Methodsmentioning

confidence: 99%

“…We investigated the changes in the peripheral circulation that led to the development of edema in patients with CRPS-I using a computer-assisted venous congestion plethysmograph, which enables the noninvasive assessment of macro- and microcirculatory parameters in the peripheral tissue [14, 15, 16, 17]. …”

Section: Introductionmentioning

confidence: 99%

Assessment of the Peripheral Microcirculation Using Computer-Assisted Venous Congestion Plethysmography in Post-Traumatic Complex Regional Pain Syndrome Type I

Schürmann¹,

Zaspel²,

Gradl³

et al. 2001

J Vasc Res

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In complex regional pain syndrome type I (CRPS-I), edema of the affected limb is a common finding. Therefore, the changes in macro- and microcirculatory parameters were investigated to elucidate the underlying pathophysiology. Twenty-four patients with post-traumatic CRPS-I and 25 gender- and age-matched healthy subjects were examined by means of an advanced computer-assisted venous congestion strain-gauge plethysmograph. The recording of the volume response of the forearm to a stepwise inflation of an occlusion cuff placed at the upper arm enabled the calculation of the arterial blood flow into the arm (Q_a), the vascular compliance (C), the peripheral venous pressure (P_v), the isovolumetric venous pressure (P_vi; = hydrostatic pressure needed to achieve net fluid filtration) and the capillary filtration capacity (CFC) – an index of microvascular permeability. The study revealed no difference in any of the parameters between the right and left hand of healthy subjects. In CRPS-I patients, however Q_a, P_v, P_vi and CFC were significantly (p < 0.01/0.001) elevated in the affected arm (Q_a 11.2 ± 7.0 ml min^–1 100 ml^–1, P_v 20.2 ± 8.1 mm Hg, P_vi 24.7 ± 4.2 mm Hg, CFC 0.0058 ± 0.0015 ml min^–1 100 ml^–1 mm Hg^–1) compared to the unaffected arm (Q_a 4.2 ± 2.4 ml min^–1 100 ml^–1, P_v 10.0 ± 5.1 mm Hg, P_vi 13.2 ± 3.7 mm Hg, CFC 0.0038 ± 0.0005 ml min^–1 100 ml^–1 mm Hg^–1) and the values obtained in healthy controls (Q_a 5.1 ± 1.3 ml min^–1 100 ml^–1, P_v 10.4 ± 4.3 mm Hg, P_vi 15.7 ± 3.3 mm Hg, CFC 0.0048 ± 0.0012 ml min^–1 100 ml^–1 mm Hg^–1). Whereas the values in the unaffected arm of CRPS-I patients revealed no difference in Q_a, P_v and P_vi but a lower CFC (p < 0.01) compared to those from healthy controls. These results suggest profound changes in both macro- and microvascular perfusion in the affected arm of CRPS-I patients. The high CFC contributes to the edema formation, and combined with the elevated P_vi, they are in agreement with the hypothesis of an inflammatory origin of CRPS.

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“…The venous pressure distal to congestion approximates the cuff pressure. 15 Pressure was maintained for 4 minutes to reach a steady state. At lower pressures, limb size reached a plateau shown in Figure 1.…”

Section: Peripheral Vascular Evaluationmentioning

confidence: 99%

Microvascular Filtration Is Increased in Postural Tachycardia Syndrome

Stewart

2003

Circulation

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Background— Postural tachycardia syndrome (POTS) is related to defective peripheral vasoconstriction of dependent extremities with redistributive hypovolemia. Methods and Results— To test whether enhanced microvascular filtration produces leg enlargement, we studied 12 patients 13 to 19 years of age with POTS and defective leg vasoconstriction and 13 age-matched healthy control subjects, with strain-gauge plethysmography used to measure venous pressure (P v ), forearm and calf blood flow, vascular capacitance, and the microvascular filtration coefficient (K f ). Measurements were made while the patient was supine and at steady state during upright tilt to 35°. Supine P v was not different in POTS, but upright leg P v tended to be increased above control. Arm and leg peripheral arterial resistance was decreased in the supine and upright positions in patients with POTS compared with control subjects ( P =0.01, upright legs). Supine K f was not significantly increased in the forearm in patients with POTS but was increased in the calf (9.3±2.2 versus 5.7±2.4 [10 −3 ] mL/100 mL per minute per mm Hg, P =0.04), correlating with calf blood flow (r s =0.84, P =0.002). K f was invariant with orthostasis. The hydraulic contribution to upright filtered flow at 35° tilt, the product of K f and P v , was approximately twice that of control (0.41±0.09 versus 0.19±0.04 mL/100 mL per minute, P =0.04). Conclusions— Increased microvascular filtration accounts for enhanced leg swelling in patients with POTS with increased arterial blood flow.

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Relationship Between Venous Pressure and tissue Volume During Venous Congestion Plethysmography in Man

Cited by 143 publications

References 13 publications

Leg intravenous pressure during head-up tilt

Leg intravenous pressure during head-up tilt

Assessment of the Peripheral Microcirculation Using Computer-Assisted Venous Congestion Plethysmography in Post-Traumatic Complex Regional Pain Syndrome Type I

Microvascular Filtration Is Increased in Postural Tachycardia Syndrome

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