Physiological reflux and venous diameter change in the proximal lower limb veins during a standardised valsalva manoeuvre

Abstract

Objectives: the aim of this study was to provide normal values for venous diameter at rest, and venous diameter and physiologic venous reflux during a standardised Valsalva manoeuvre. The impact of the patient's sex, body mass index (BMI), and family history was investigated. Material and Methods: eighty legs of 40 healthy volunteers were investigated in a supine position. The median age was 28 years (range 20-66 years). The common femoral vein (CFV), the proximal superficial femoral vein (SFV) and the proximal long saphenous vein (LSV) were investigated by duplex sonography. The following parameters were assessed: resting diamtere (VD(rest)) and maximum diameter (VD(max)) as well as reflux time (t(r)) during the Valsalva manoeuvre. The Valsalva manoeuvre was elicited by a forceful expiration into a tube system. The standard values used were a pressure of 30 mmHg, established within 0.5 seconds (s) and maintained over a time period of at least 3 s. Results: mean VD(rest) and VD(max) were 8.3 ± 2.2 and 11.1 ± 2.8 mm in the CFV, 5.9 ± 1.3 and 7.2 ± 1.6 mm in the SFV and 3.5 ± 0.9 and 4.3 ± 1.4 mm in the LSV. Mean valus for t(r) were 0.61 ± 0.63 s in the CFV, 0.25 ± 0.26 mm in the SFV and 0.28 ± 0.40 s in the LSV. A BMI > 22.5 kg/m2 was associated with statistically significant larger values for VD(rest) and t(r). If adjusted for BMI, t(r) in the SFV and LSV did not differ by sex. For healthy subjects with first-degree relatives suffering from varicose veins (n = 19), mean VD(rest) in the SFV as well as VD in the LSV was significantly larger (p = 0.02, 0.05 respectively). Coefficients of variation for repeated measurements (VD(rest), VD(max), t,) in the same segment varied between 3.3% and 16.4% for the three investigated sites. Conclusions: normal values for VD(rest) and VD(max) as well as reflux time during a stansdardised Valsalva manouevre were assessed in the proximal lower limb veins. The influences of BMIO, sex and family history were investigated. The described standardised Valsalva manoeuvre led to highly reproducible results and can be recommended for further research projects or as a routine for the assessment of venous reflux.