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Home > Vascular Annual Meeting > paolini_challenging_venous

Challenging Venous Outflow with Reactive Hyperemia to Detect Obstruction in Postthrombotic Venous Disease

David J. Paolini, Linda S. Jones, Anthony J Comerota.
The Toledo Hospital, Toledo, Ohio.

OBJECTIVES: Although venous obstruction is an important element of the pathophysiology of postthrombotic venous disease, its assessment is overlooked due to insensitive techniques. Post-occlusive reactive hyperemia (PORH) identifies sub-clinical arterial disease; therefore, we used the same physiologic principle to stress venous outflow. The purpose of this study is to assess PORH as a tool to unmask the contribution of venous obstruction to the pathophysiology of patients with postthrombotic syndrome (PTS).

METHODS: Twenty-two normal and 22 postthrombotic limbs were studied with resting and PORH maximal venous outflow (MVO) after inflating a thigh blood pressure cuff 15 mmHg above systolic pressure for 3 minutes. Volume plethysmography measured venous outflow volume, outflow fraction and change in volume over time (ΔV/t) during three separate time intervals (0-1 second; 1-3 seconds; and 0-3 seconds) and total limb emptying time.

RESULTS: Venous outflow volumes were reduced in postthrombotic patients in all time periods; significantly so from 0-1 sec and 0-3 sec in the resting examination, and at all time intervals after PORH [Table 1a]. PORH generated changes in venous outflow only in normals [Table 1b]. Outflow fractions did not change from the resting to the PORH examination in either group [Table 2]. The ΔV/t or slope of the outflow curve differed between the groups during all time periods [Table 3]. The total emptying time is significantly longer for postthrombotics in both the resting and PORH examinations [Table 4].

CONCLUSIONS: Venous outflow volumes and fractions are reduced in patients with PTS. PORH stimulated changes in venous outflow only in normals. Challenging the limb with PORH did not alter outflow fractions in either group; however, the ΔV/t was significantly reduced during all time intervals in postthrombotics. These differences in volume change and ΔV/t in postthrombotics further clarify pathophysiologic changes which may help physicians better understand postthrombotic venous disease. The total emptying time can strengthen the diagnostic power of a global lower extremity venous examination.

AUTHOR DISCLOSURES: D.J. Paolini, None; L.S. Jones, None; A.J. Comerota, None.