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The direct effect of leg position on calf blood flow measured by venous occlusion plethysmography

Summary

Background

Venous occlusion plethysmography is commonly used to assess changes in calf blood flow (CBF). Although the leg is often positioned above the level of the heart to aid venous emptying during periods of cuff deflation, its direct effect on measured CBF is not known. We therefore planned to determine if CBF is affected by raising the calf region at the same body position during constant vasoconstrictor sympathetic nerve drive and haemodynamic variables.

Methods

We measured concomitant heart rate, arterial pressure, muscle sympathetic nerve activity (MSNA), calf blood flow (CBF) and calf vascular resistance (CVR) in the semi-supine position with the leg supported by the heel at various elevations above the horizontal level.

Results

In 26 subjects we found that raising the leg to 40 ± 0.65° significantly increased CBF by about 23 ±4.7% at constant haemodynamic variables and MSNA levels. Furthermore, in 10 of the 26 subjects this effect was graded within the same constant conditions. When the calf region was elevated to two positions at 22 ± 3.5° and 40 ± 1.5° from the horizontal level the increase in CBF, respectively, amounted to 13 ±5.9% and 37 ±5.9%.

Conclusions

It was shown that measurement of CBF by strain gauge venous occlusion plethysmography is directly affected by the position of the calf region above the horizontal level. It is suggested that this could confound measurement of calf blood flow in longitudinal and interventional studies.

References

  1. Altenkirch HU, Fransson L, Koch G. Assessment of arterial and venous circulation in upper and lower extremities by venous occlusion strain gauge plethysmography. Normal values and reproducibility. Vasa 1989;18:140–5.

    Google Scholar 

  2. Altenkirch HU, Koch G, Koralewski HE. Variability and reproducibility of arterial and venous circulation parameters in the forearm and calf measured at one-week intervals. Vasa 1990; 19:21–5.

    Google Scholar 

  3. Knox R, Cramer M, Fell G, Breslau P, Beach K, Strandness DE. Pitfall of venous occlusion plethysmography. Angiology 1982; 33:268–76.

    Google Scholar 

  4. Pallares LC, Deane CR, Baudouin SV, Evans TW. Strain gauge plethysmography and Doppler ultrasound in the measurement of limb blood flow. Eur J Clin Invest 1994;24:279–86.

    Google Scholar 

  5. Roberts DH, Tsao Y, Breckenridge AM. The reproducibility of limb blood flow measurements in human volunteers at rest and after exercise by using mercury-in-Silastic strain gauge plethysmography under standardized conditions. Clin Sci (Lond) 1986;70:635–8.

    Google Scholar 

  6. Corrigan JH, Graham LN, Smith PA, Stoker JB. Sympathetic nerve activity and the reproducibility of calf blood flow measurement in hypertension. J Hypertens 2002;20(Suppl 4):S291.

    Google Scholar 

  7. Corrigan JH, Huggett RJ, Mary DASG, Mackintosh AF. Differences between right and left calf blood flow as measured by venous occlusion plethysmography. J Hypertens 2003;21(Suppl 4):S231–2.

    Google Scholar 

  8. Corrigan JH, Stoker JB. The variability of measuring calf blood flow by plethysmography in hypertension. J Hypertens 2001; 19(Suppl 2):S199.

    Google Scholar 

  9. Fehling PC, Arciero PJ, MacPherson CJ, Smith DL. Reproducibil-ity of resting peripheral blood flow using strain gauge plethysmography. Int J Sports Med 1999;20:555–9.

    Google Scholar 

  10. Jorfeldt L, Rutberg H. Comparison of dye-dilution and plethys-mographic blood flow measurements: an evaluation of the influence of invasive technique on blood flow and on arterial and femoral venous substrate variables in man. Clin Sci (Lond) 1990;79:81–7.

    Google Scholar 

  11. Greenwood JP, Stoker JB, Mary DASG. Single-unit sympathetic discharge: quantitative assessment in human hypertensive disease. Circulation 1999;100:1305–10.

    Google Scholar 

  12. Scott EM, Greenwood JP, Gilbey SG, Stoker JB, Mary DASG. Water ingestion increases sympathetic vasoconstrictor discharge in normal human subjects. Clin Sci (Lond) 2001;100:335–42.

    Google Scholar 

  13. Scott EM, Greenwood JP, Stoker JB, Mary DASG, Gilbey SG. Sympathetic nerve hyperactivity is associated with increased peripheral vascular resistance in hypopituitary patients with growth hormone deficiency. Clin Endocrinol 2002;56:759–63.

    Google Scholar 

  14. Macefield VG, Wallin BG, Vallbo AB. The discharge behaviour of single vasoconstrictor motoneurones in human muscle nerves. J Physiol (Lond) 1994;481:799–809.

    Google Scholar 

  15. Vallbo AB, Hagbarth KE, Torebjo¨rk HE, Wallin BG. Somatosen-sory, proprioceptive and sympathetic activity in human peripheral nerves. Physiol Rev 1979;59:919–57.

    Google Scholar 

  16. Mark AL, Victor R, Nerhed C, Wallin BG. Microneurographic studies of the mechanisms of sympathetic nerve responses to static exercise in humans. Circ Res 1985;57:461–9.

    Google Scholar 

  17. Sundlöf G, Wallin BG. The variability of muscle nerve sympathetic activity in resting recumbent man. J Physiol (Lond) 1977;272:383–97.

    Google Scholar 

  18. Wallin BG, Burke D, Gandevia SC. Coherence between the sympathetic drives to relaxed and contracting muscles of different limbs of human subjects. J Physiol (Lond) 1992;455:219–33.

    Google Scholar 

  19. Ng AV, Callister R, Johnson DG, Seals DR. Age and gender influence muscle sympathetic nerve activity at rest in healthy humans. Hypertension 1993;21:498–503.

    Google Scholar 

  20. Scherrer U, Randin D, Tappy L, Vollenweider P, Jequier E, Nicod P. Body fat and sympathetic nerve activity in healthy subjects. Circulation 1994;89:2634–40.

    Google Scholar 

  21. Sundlöf G, Wallin BG. Human muscle sympathetic activity at rest. Relationship to blood pressure and age. J Physiol (Lond) 1978;274:621–37.

    Google Scholar 

  22. O’Leary D, Kimmerly DS, Cechetto AD, Shoemaker JK. Differential effect of head-up tilt on cardiovagal and sympathetic baroreflex sensitivity in humans. Exp Physiol 2003;88:769–74.

    Google Scholar 

  23. Jorfeldt L, Vedung T, Forsström E, Henriksson J. Influence of leg position and environmental temperature on segmental volume expansion during venous occlusion plethysmography. Clin Sci (Lond) 2003;104:599–605.

    Google Scholar 

  24. Vissing SF, Nielsen SL. Regional blood volume in man determined by radiolabelled erythrocytes. Clin Physiol 1988;8: 303–8.

    Google Scholar 

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Correspondence to Joanna Burns.

Additional information

This work was funded by the Hypertension Trust and the British Heart Foundation.

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This is an open access article distributed under the CC BY-NC license. https://doi.org/creativecommons.org/licenses/by/4.0/

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Corrigan, J.H., Burns, J., Huggett, R.J. et al. The direct effect of leg position on calf blood flow measured by venous occlusion plethysmography. Artery Res 2, 44–48 (2008). https://doi.org/10.1016/j.artres.2007.11.001

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  • DOI: https://doi.org/10.1016/j.artres.2007.11.001

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