Pulsatile flow in venous perforators of the lower limb

Kate N. Thomas, Travis D. Gibbons, Holly A. Campbell, James D. Cotter, Andre M. van Rij

Research output: Contribution to journalArticlepeer-review

8 Scopus citations

Abstract

Teaching traditionally asserts that the arterial pressure pulse is dampened across the capillary bed to the extent that pulsatility is nonexistent in the venous circulation of the lower limbs. Herein, we present evidence of transmission of arterial pulsations across the capillary network into perforator veins in the lower limbs of healthy, heat-stressed humans. Perforator veins are connections from the superficial veins that drain into the deep veins. When assessed using ultrasound at rest, they infrequently demonstrate flow, and a pulsatile flow waveform is not described. We investigated perforator vein pulsatility in 10 young, healthy volunteers who underwent passive heating by 2_C core body temperature via a hot-water-perfused suit, and 5 who also underwent active heating by 2_C via low-intensity cycling while wearing the hot-water-perfused suit. At 0.5_C increments in temperature, blood velocity in an ankle perforator vein was measured using duplex ultrasound. In all perforators with heating, sustained flow was demonstrated, with a pulsatile waveform that was synchronous with the cardiac cycle. The maximum velocity was 30 ± 13 cm/s with passive heating and approximately half with active heating (P = 0.04). The small veins of the skin at the ankle also demonstrated increased perfusion with pulsatility, seen with low-velocity microvascular imaging technology. We consider explanations for this pulsatility and conclude that it is propagated from the arterial inflow through the skin microcirculation as a result of increased dilatation and flow volume and that this is a normal response to increased skin blood flow.

Original languageEnglish (US)
Pages (from-to)R59-R67
JournalAmerican Journal of Physiology - Regulatory Integrative and Comparative Physiology
Volume323
Issue number1
DOIs
StatePublished - Jul 1 2022
Externally publishedYes

Keywords

  • hemodynamics
  • phasicity
  • ultrasound
  • vein
  • waveform

ASJC Scopus subject areas

  • General Medicine

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