The Vasculab manoeuvre: simulating walking in venous investigations

Passariello, Fausto; Cappelli, Massimo; Ermini, Stefano

doi:10.1016/j.rvm.2016.08.002

Cited by 4 publications

(3 citation statements)

References 5 publications

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“…This is a necessary first step before the CMP function can be understood or the effects of intervention or compression on the EF can be studied. The BWTM is a broad term that describes different manoeuvres which rely on the transfer of weight backwards and forwards with the feet together (Parana`) 24 or weight onto a leading leg and back again (Vasculab), 18 to name two of them. The key point is that it is the weight transfer that may be responsible for the pumping, rather than the range of movement (ROM) of the ankle joint.…”

Section: Discussionmentioning

confidence: 99%

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Optimizing calf muscle pump function

2017

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Background The tip toe manoeuvre has been promoted as the gold standard plethysmography test for measuring calf muscle pump function. The aim was to compare the tip toe manoeuvre, dorsiflexion manoeuvre and a body weight transfer manoeuvre using the ejection fraction of air-plethysmography and evaluate which has the best pumping effect. Methods Sixty-six archived tracings on 22 legs were retrieved from an air-plethysmography workshop and analysed. Pumping performance was measured using the calf volume reduction after each manoeuvre. Results Expressed as median [inter-quartile range], body weight transfer manoeuvres resulted in a significantly greater ejection fraction (%) than tip toe manoeuvres at 59.7 [53.5-63.9] versus 42.6 [30.5-52.6], P < 0.0005 (Wilcoxon). There was no significant difference in the ejection fraction between the tip toe manoeuvre versus dorsiflexion manoeuvre, P = 0.615. The repeatability (confidence interval: 95%) of 66 ejection fraction tests was excellent: tip toe manoeuvre (±1.2), dorsiflexion manoeuvre (±1.3) and body weight transfer manoeuvre (±1.6). Conclusion The body weight transfer manoeuvre appears to be a better method of measuring the full potential of the calf muscle pump with a 40.1% relative increase in the ejection fraction compared to a tip toe manoeuvre. Exercises which involve body weight transfers from one leg to the other may be more important in optimizing calf muscle pump function than ankle movement exercises.

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Section: Discussionmentioning

confidence: 99%

“…All workshop participants had an ultrasound scan of their venous system and CMP. 18 Subjects with overt clinical venous disease (C 2 or greater in the CEAP classification), 19 or significant reflux (>0.5 s on duplex) 20 were excluded from the analysis.…”

Section: Data Retrievalmentioning

confidence: 99%

Optimizing calf muscle pump function

2017

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“…ST is widely practiced in most vascular labs, though nowadays several old and new manoeuvres have shown that ST is not the best choice to elicit the venous reflux [8][9][10][11][12] .…”

Section: Discussionmentioning

confidence: 99%

Experimental validation of the Paraná manoeuvre compared to the squeezing test

Ermini¹,

Passariello²,

Cappelli³

et al. 2017

JTAVR

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Background and aimThe squeezing test (ST) is widely practiced, owing to its simple execution. In 1997, the Paraná (P) manoeuvre was proposed. This manoeuvre consists in a gently pushingfrom-the-rear or pulling-from-the-front. Our aim was to compare the hemodynamic effects of ST and P during the muscle systole and diastole. Method 57 patients underwent a diagnostic Duplex examination. 57 legs were examined, one leg for each patient, exploring just one venous segment for each leg. 37 patients were affected by incompetence of the terminal valve of the saphenousfemoral junction. 20 patients presented just telangiectasiae (C1) and were used to compare the manoeuvres in competent popliteal veins. Measurements were taken on 57 venous segments (20 competent popliteal veins, 13 incompetent saphenous-femoral junctions, 13 incompetent trunks of great saphenous vein and 11 re-entry perforating veins). Comparisons were worked out using a two-tailed paired t-test. Results Compared to ST, P moves 68% more blood volume in systole in the competent popliteal vein (p=0.00014 *** ), while the diastolic phase of P is 2.52 times longer in incompetent SFJ (p=0.00003 *** ), 1.83 times longer in the incompetent GSV trunk (p=0.0015 ** ) and 3.27 times longer in the re-entry perforating veins (p=0.07 n.s.). However, this last result, near to significance, needs further investigations. In addition, our data about the systolic acceleration did not show any meaningful result. Conclusion P is a better test than ST in the evaluation and quantification of reflux and could be of paramount clinical importance in improving diagnostics in venous diseases, being actually practised since 20 y in many vascular labs. P does not rely on the size of the operator's hand or the size of the patient's calf and investigates a condition which is almost near to the physiological posture balance.

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