Influence of Abdominal Pressure on Lower Extremity Venous Pressure and Hemodynamics: A Human In-vivo Model Simulating the Effect of Abdominal Obesity

Chronic Venous and Lymphatic Disease


The Influence of Abdominal Pressure on Lower Extremity Venous Pressure and Hemodynamics: A Human In-vivo Model Simulating the Effect of Abdominal Obesity


Willenberg T, Clemens R, Haegeli LM, et al (Univ Hosp, Berne, Switzerland; Univ Hosp Zurich, Switzerland) Eur J Vasc Endovasc Surg 41:849–855, 2011§



G.L. Moneta, MD



Evidence Ranking


• C



Expert Rating


• 1



Abstract



Objective


To demonstrate that abdominal pressure impacts venous flow and pressure characteristics.



Methods


Venous pressure at the femoral vein was measured in 6 non-obese subjects (mean BMI 22 ± 2 kg/m2) that were exposed to a circumferential cuff placed around the abdominal trunk and inflated to 20 and 40 mmHg. In a second step non-obese subjects (n = 10, BMI 21.8 ± 1.8 kg/m2) exposed to this cuff compression were studied for duplexsonographic parameters at the femoral vein. Duplexsonographic results were compared to subjects with abdominal obesity (n = 22, BMI 36.2 ± 5.9 kg/m2) in whom duplexsonographic parameters at the femoral vein were studied without cuff compression.



Results


Intravenous pressure increased with pressure application in all participants (p = 0.0025). Duplex examination of 10 non-obese subjects revealed increasing venous diameter (p < 0.0001) and decreasing venous peak and mean velocity (all p < 0.0001) when cuff pressure was applied. Duplex parameters with cuff pressure application of 20 and 40 mmHg respectively, were similar to those in obese subjects that were studied without pressure application.



Conclusions


External abdominal pressure application creates venous stasis in lower limbs. Results of this study indicate that abdominal obesity might induce resistance to venous backflow from the lower limbs (Fig 1).


image

Figure 1 Test arrangement for duplexsonographic assessment of venous flow characteristics of the lower extremities in non-obese participants (BMI 20–25 kg/m2). All subjects were examined in a supine position with 10° degree trunk elevation. The pressure cuff was placed at the mid abdomen. Assessment was performed with the cuff deflated and with the cuff inflated at 20 mmHg and 40 mmHg. (Reprinted from European Journal of Vascular and Endovascular Surgery, Willenberg T, Clemens R, Haegeli LM, et al. The influence of abdominal pressure on lower extremity venous pressure and hemodynamics: a human in-vivo model simulating the effect of abdominal obesity. Eur J Vasc Endovasc Surg. 2011;41:849–855. Copyright 2011, with permission from the European Society for Vascular Surgery.)

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Apr 1, 2017 | Posted by in CARDIOLOGY | Comments Off on Influence of Abdominal Pressure on Lower Extremity Venous Pressure and Hemodynamics: A Human In-vivo Model Simulating the Effect of Abdominal Obesity

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