Physiological reflux and venous diameter change in the proximal lower limbveins during a standardised Valsalva manoeuvre

Objectives: the aim of this study was to provide normal values for venous d iameter at rest, and venous diameter and physiologic venous reflux during a standardised Valsalva manoeuvre. The impact of the patient's sex, batty ma ss index (BMI), and family history runs investigated Material and methods: eighty legs of 40 healthy volunteers were investigate d in a supine position. The median age was 28 years (range 20-66 years). Th e common femoral vein (CFV), the proximal superficial femoral vein (SFV) an d the proximal long saphenous vein (LSV) were investigated by duplex sonogr aphy. The following parameters were assessed: resting diameter (VDrest) and maximum diameter (VDmax) as well as reflux time (t(r)) during the Valsalva manoeuvre. The Valsalva manoeuvre was elicited by a forceful expiration in to a tube system. The standard values used were a pressure of 30 mmHg, esta blished within 0.5 seconds (s) and maintained over a time period of at leas t 3 s. Results: mean VDrest and VDmax were 8.3 +/- 2.2 and 11.1 +/- 2.8 mm in the CFV, 5.9 +/- 1.3 and 7.2 +/- 1.6 min in the SFV and 3.5 +/- 0.9 and 4.3 +/- 1.4 mm in the LSV. Mean values for t(r) were 0.61 +/- 0.63 s in the CFV 0. 25 +/- 0.26 s in the SFV and 0.28 +/- 0.40 s in the LSV. A BMI > 22.5kg/m(2 ) was associated with statistically significant larger values for VDrest an d t(r). If adjusted for BMI, t(r) in the SFV and the LSV did not differ by sex. For healthy subjects with first-degree relatives suffering from varico se veins (n = 19), mean VDrest in the SFV as well as VD in the LSV was sign ificantly larger (p = 0.02, 0.05, respectively). Coefficients of variation for repented measurements (VDrest, VDmax, t(r)) i n the same segment varied between 3.3% and 16.4% for the three investigated sites. Conclusions: normal values for VDrest and VDmax as well as reflux time duri ng a standardised Valsalva manouevre were assessed in the proximal lo lower limb veins. The influences of BMI, sex and family history were investigate d. The described standardised Valsalva manoeuvre led to highly reproducible results ard Ca IZ be recommended for further research projects or as a rou tine procedure for the assessment of venous reflux.