Presence of Lower-Extremity Venous Pulsatility is not always the Result of Cardiac Dysfunction

Abstract

IntroductionThe presence of peripheral venous pulsatility is widely recognized and commonly attributed to cardiac dysfunction; however, the precise cause(s) have been poorly defined in the literature. We have noted multiple patterns of venous pulsatility, often in patients with no history of heart disease. In a normal, high compliance venous system, cardiac pulsatility is continually dampened with distance from the heart. We theorized that in a low-compliance system, the pulsatility would be transmitted throughout and its presence is a reflection of the hemodynamic state of the lower extremity venous system.MethodsWe evaluated the right popliteal vein in 30 normal volunteers (average age 35) with no history of heart disease and minimal venous disease (C-Class range 0–2, average 0.4). The right popliteal vein was chosen for its distal anatomic location and to avoid any potential of left iliac vein compression. Three spectral waveforms were obtained in the following manner: (1) a left lateral supine position with the right popliteal vein at the level of the right atrium, (2) after standing for >3″ with no right leg weight bearing or muscle contraction, and (3) after 10 seconds of vigorous plantar/dorsiflexion.ResultsIn a supine position, all 30 limbs had normal respiratory phasicity with minor variation. In every patient, after quiet standing there was very low velocity forward flow with a discernable pulsatility. Immediately after dorsiflexion, flow became highly pulsatile.ConclusionA total of 100% of patients demonstrated highly pulsatile flow when the lower extremity venous system was filled to resting hydrostatic pressure. Although cardiac dysfunction may result in venous hypertension, reducing system compliance, the presence of pulsatile venous flow in the lower extremity can be demonstrated in all persons and is therefore a function of venous hemodynamics.