Lower limb deep venous flow in patients with peripheral vascular disease

Purpose: A prospective controlled study was undertaken to determine how per ipheral vascular disease (PVD) influences flow in the deep veins of the leg . Methods: Eighty-nine patients with peripheral vascular disease and 35 age-m atched control subjects were studied. The popliteal vein diameter and flow velocity were measured at rest by means of color duplex ultrasound scanning , and these measurements were compared with the ankle-brachial pressure ind ex. For 23 subjects, measurements were also performed during reactive hyper emia and then repeated after venous return from the foot was prevented by a n ankle cuff, Results: There was a significant correlation between the ankle-brachial pre ssure index and the popliteal vein diameter (r = 0.35, P < .001) but a nega tive correlation between the ankle-brachial pressure index and venous flow velocity among patients with PVD (r = -0.24, P = .002). In PVD patients the diameter decreased further in reactive hyperemia, whereas it increased in control subjects (P < .001). Preventing venous return from the foot in PVD patients fed to diameter increase at rest and abolished the reduction in di ameter caused by reactive hyperemia. Despite the reduction in diameter duri ng reactive hyperemia, flow velocity increased less in patients with PVD th an it did in control subjects (P = .01). Conclusion: Chronic tissue ischemia results in constriction of the poplitea l vein. This appears to be an active process related to the washout of humo ral factors from ischemic tissues distally, which leads to an increase in n ow velocity. The latter may confer some protection against the deep vein th rombosis that would otherwise tend to occur with low venous flow rates.