Historical view onto the contribution of phlebodynamometry to the knowledge of venous hemodynamics in the lower extremity

Abstract

Contribution of phlebodynamometry to the knowledge of the venous hemodynamics in the lower extremity is assessed from the historical point of view. Höjensgard, Stürup, and Arnoldi yielded in the 50's and 60's of the last century substantial information concerning changes of venous pressure in superficial and deep veins of the lower extremity arising during calf pump activity. They confirmed the previous finding that the venous pressure in the quiet standing position corresponds to the column of blood extending from the point of measurement to the heart. During calf pump activity, the systolic-diastolic amplitudes in lower leg veins are very marked; in contrast to that, they are only modest in the popliteal vein. The mentioned authors documented marked decrease in pressure in the posterior tibial vein as well as in the great saphenous vein arising during calf pump activity in healthy people. Contrary to that, the pressure in the popliteal vein did not decrease; it kept principally the value of the resting hydrostatic pressure. This difference of pressure between the thigh veins and the lower leg veins has been called ambulatory pressure gradient; its value in the examined patient cohort was 37.4±6.4 mm Hg. Ambulatory pressure gradient constitutes the suction force that triggers reflux in incompetent superficial and deep veins; this refluxing flow causes ambulatory venous hypertension. Simultaneous pressure recordings in the posterior tibial vein and great saphenous vein in healthy volunteers documented that the systolic and diastolic pressure amplitudes were similar in both veins. The systolic pressure in the posterior tibial vein increased on average by 75 mm Hg; this generates a strong impulse propelling the venous blood mainly into the popliteal vein, and partially into the great saphenous vein. Thus, there is a double-barreled outflow of venous blood from the lower extremity toward the heart. The steep increase in systolic pressure in the great saphenous vein gave evidence of the incompetence of the calf perforators system in healthy people. At present, plethysmography is able to yield similar information on the hemodynamic status of the lower limbs like phlebodynamometry.