INCREASED ARTERIAL INFLOW IN EXTREMITIES WITH CHRONIC VENOUS INSUFFICIENCY - AN IMPORTANT AND UNAPPRECIATED HEMODYNAMIC PARAMETER

Background. The purpose of this study runs to evalate and analyze arte rial inflow (AI) In lower extremities of patients with symptoms of chr onic venous insufficiency (CVI) and of members of a healthy control gr oup. Methods. Foot mercury-in-silicone strain gauge plethysmography wa s used to measure AI, venous reflux, and muscle pump efficiency in 388 extremities of 194 patients with symptoms of CVI. Severe stage III sy mptoms (Society for Vascular Surgery/International Society for Cardiov ascular Surgery classification) were present in 84 extremities, modera te stage II symptoms were present in 81 extremities, and mild stage I symptoms were present in 158 extremities. No symptoms, stage 0, were f ound in 65 contralateral extremities of patients with unilateral sympt oms. Identical parameters were measured in 70 extremities of 35 health y subjects in a control group. AI in each staged group was compared wi th that of the control group and with that of the other groups with sy mptoms with the use of Kruskall-Wallis analysis of multiple variances. Results. The mean AI (+/-SD) in milliliters per 100 ml of foot tissue per minute in the extremities in the control group tons 0.82 +/- 0.48 . In the extremities without symptoms, contralateral to those with sym toms in patients with unilateral disease, the AI was 1.24 +/- 0.88. In extremities with mild symptoms the AI was 1.54 +/- 1.20, in extremiti es with moderate symptoms it was 2.88 +/- 1.70, and in extremities wit h severe symptoms if was 6.25 +/- 4.91. The AI was significantly incre ased in all extremities of patients with CVI (stages 0 to III) wizen c ompared with that of patients in the control group. Extremities with s tage II and III disease had significantly higher AI than did extremiti es zuith stage 0 and stage I disease. The difference in AI between ext remities with stage 0 and I disease was not statistically significant, and no significant difference in Al was seen between extremities with stage II and III disease. Conclusions. When plethysmographic methods are used to evaluate extremities zuith CVI high AI, if not considered can overrepresent the true magnitude of reflux. High AI may indicate p resence of primary anatomic arterioventricular fistulas, or it may be the consequence of inflammatory changes and secondary functional arter ioventricular shunting. Increased AI in contralateral extremities with no symptoms may point to the role of high flow in the pathogenesis of CVI. Clarification of this question requires further investigation.