Hyperemic maximal venous outflow unmasks symptomatic lower extremity venous obstruction.
Venous obstruction is an underappreciated and often unrecognized component of the pathophysiology of symptomatic chronic venous disease (CVD). Moreover, standard methods used to detect venous obstruction, such as maximal venous outflow, are inadequate as they typically test patients at rest and in the supine position when the pathophysiology of CVD is defined in the upright patient performing exercise. This report describes a patient with incapacitating venous claudication in whom standard noninvasive venous function tests were normal and whose phlebography was interpreted as showing no evidence of venous obstruction. A postocclusive reactive hyperemic technique was used to unmask significant outflow obstruction, leading to operative correction and subsequent symptom resolution.
Paolini
David J
DJ
Jobst Vascular Center, The Toledo Hospital, Toledo, Ohio 43606, USA.
Jones
Linda S
LS
Comerota
Anthony J
AJ
D000328:Adult; D000783:Aneurysm / Q000150:complications / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D000925:Anticoagulants / Q000627:therapeutic use; D001783:Blood Flow Velocity; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects; D003251:Constriction, Pathologic; D005260:Female; D005268:Femoral Vein / Q000473:pathology / Q000503:physiopathology*; D006801:Humans; D006940:Hyperemia / Q000503:physiopathology*; D007383:Intermittent Claudication / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology / Q000628:therapy; D048228:Intermittent Pneumatic Compression Devices; D035002:Lower Extremity / Q000098:blood supply*; D010690:Phlebography; D012039:Regional Blood Flow; D019722:Sphygmomanometers; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures; D014689:Venous Insufficiency / Q000150:complications / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology / Q000628:therapy; D014690:Venous Pressure
D000925:Anticoagulants