To evaluate the response of the deep veins of the leg to an inclination from supine (reverse Trendelenburg) and assess the influence of gradient elastic compression stockings on such response.
Design:
Prospective study in healthy volunteers.
Setting:
University affiliated community hospital, Glenview, Illinois, USA.
Participants:
Ten healthy volunteers.
Interventions:
High-resolution ultrasound imaging was carried out to study the leg veins in the supine and 45° reverse Trendelenburg position, with and without thigh-length gradient elastic compression stockings. Main outcome measures: Vein cross-sectional area changes after the use of compression stockings in the supine position and after 30 and 60 min in a reverse Trendelenburg position.
Results:
Significant dilatation of the leg veins was observed during the reverse Trendelenburg position. This was partially prevented by the use of gradient elastic compression stockings.
Conclusion:
Elastic compression of the legs significantly reduces the dilatation of the medial gastrocnemius veins of the calf that occurs in healthy volunteers as a result of inclination from supine.
KravitzEKarinoT. Pathophysiology of deep vein thrombosis. In: LeclercJR, Editor. Venous thromboembolic disorders. Philadelphia: Lea & Febiger, 1991: 54–64.
2.
PollackAAWoodEH. Venous pressure in the saphenous vein and the ankle in man during exercise and changes in posture. J Appl Physiol1949; 1: 649–62.
3.
ComerotaAJStewartGJWhiteJV. Combined dihydroergotamine and heparin prophylaxis of postoperative deep vein thrombosis: Proposed mechanism of action. Am J Surg1985; 150: 39–44.
4.
ComerotaAJStewartGJ. Operative venous dilation and its relation to postoperative deep venous thrombosis. In GoldhaberSZ, editor. Prevention of venous thromboembolism. New York: Marcel Dekker, 1993: 25–50.
5.
StewartGSchaubRNiewiarowskeS. Products of tissue injury: Their induction of venous endothelial damage and blood cell adhesion in the dog. Arch Pathol Lab Med1980; 104: 409–13.
6.
KakkarVVWelzelDMurrayWJGMalonePJonesD. Possible mechanism of the synergistic effect of heparin and dihydroergotamine. Am J Surg1985; 150 (4A): 33–8.
7.
ComerotaAJStewartGJAlburgerPDSmalleyKWhiteJV. Operative venodilation: A previously unsuspected factor in the cause of postoperative deep vein thrombosis. Surgery1989; 106: 301–9.
8.
StewartGJLachmanJWAlburgerPDZiskinMCPhilipsCMJensenK. Intraoperative venous dilation and subsequent development of deep vein thrombosis in patients undergoing total hip or knee replacement. Ultrasound Med Biol1990; 16: 133–140
9.
SmithPD ColeridgeHastyJHScurrJH. Venous stasis and vein lumen changes during surgery. Br J Surg1990; 77: 1055–9.
10.
SmithPD ColeridgeHastyJHScurrJH. Deep vein thrombosis: Effect of graduated compression stockings on distension of the deep veins of the calf. Br J Surg1991; 78: 724–6.
11.
BeebeDSMcNevinMPBelaniKJLetourneauJGCrainMRGoodaleRL. Evidence of venous stasis after abdominal insufflation for laparoscopic cholecystectomy. Anesthesiology1992; 77 (3A): 148.
12.
MillardJAHillBBCookPFenoglioME. Intermittent sequential pneumatic compression of the legs in the prevention of venous stasis associated with pneumoperitoneum. 100th Scientific Session of the Western Surgical Association1992, San Antonio. Texas: 32.
13.
HamerJDMalonePCSilverIA. The Po2 in venous valve pockets: its possible bearing on thrombogenesis. Br J Surg1981; 68: 166–70.
14.
SevittS. Pathology and pathogenesis of deep vein thrombi. In: BerganJJYaoJST, Editors. Venous problems. Chicago: Year Book, 1978: 257–79.
15.
VirchowR. Neuer fall von Todlicher Emboli der Lungenarterie. Arch Pathol Anat1856; 10: 225–8.
16.
WesslerS. Thrombosis in the presence of vascular stasis. Am J Med1962; 33: 648–51.
17.
HavigO. Deep vein thrombosis and pulmonary embolism. An autopsy study with multiple regression analysis of possible risk factors. Acta Chir Scand1977; Supplement 478:1–120.
18.
GimbroneMAJr. Vascular endothelium: Nature's blood container. In: GimbroneMAJr, Editor. Vascular endothelium in hemostasis and thrombosis. Edinburgh: Churchill Livingstone, 1986: 1–13.
19.
SchaubRDLynchPRStewartGJ. The response of canine veins to three types of abdominal surgery: A scanning and transmission electron microscopic study. Surgery1978; 83: 411–24.
20.
CapriniJAArcelusJITraversoCIVittumD. Hypercoagulability after laparoscopic cholecystectomy. Thromb Haemostas1991; 65: 1347.
21.
AiranMAppelNBerciGCoburgAJCohenMCuschieriA, Retrospective and prospective multi-institutional laparoscopic cholecystectomy study organized by the Society of American Gastrointestinal Endoscopic Surgeons. Surg Endosc1992; 4: 169–76.
ScurrJHIbrahimSZFaberRGLe QuesneLP. The efficacy of graduated compression stockings in the prevention of deep vein thrombosis. Br J Surg1977; 64: 371–3.
24.
JefferyPCNicolaidesAN. Graduated compression stockings in the prevention of postoperative deep vein thrombosis. Br J Surg1990; 77: 380–3.
25.
LawrenceDKakkarVV. Graduated, static, external compression of the lower limb: A physiological assessment. Br J Surg1980; 67: 119–21.
26.
HastyJH. Physiology of vascular compression. In: GoldhaberSZ, Editor. Prevention of venous thromboembolism. New York: Marcel Dekker. 1993; 145–66.
