The human lower leg muscle pump functions as a flow diverter pump, maintaining low ambulatory venous pressures during locomotion.

IF 2.8 2区 医学 Q2 PERIPHERAL VASCULAR DISEASE Journal of vascular surgery. Venous and lymphatic disorders Pub Date : 2024-10-22 DOI:10.1016/j.jvsv.2024.101996
Roman A Tauraginskii, Fedor Lurie, Sergei Simakov, Rishal Agalarov, Pavel Khramtsov, Maxim Babushkin, Tatiana Gurina, Denis Borsuk
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Abstract

Objective: Ambulatory venous pressure (AVP) is the drop of pressure observed in the superficial veins of the lower leg during movement. This phenomenon has been linked to the function of the calf muscle pump (CMP) and the competence of venous valves. Nevertheless, the concept of the CMP function remains controversial. This study aimed to elucidate the association between lower leg muscles activity, changes in pressure in distinct venous segments, and lower extremity arterial blood supply in healthy subjects during various types and intensities of exercise.

Methods: Twelve legs of nine healthy volunteers were enrolled in the study. Continuous pressure (intramuscular vein [IV] and three great saphenous vein [GSV] points) and surface electromyography data (gastrocnemius and anterior tibial [ATM] muscles) were recorded during treadmill walking, running, and plantar flexion exercises. The pressure gradient (ΔP, mmHg) between adjacent points of measurement was calculated. Minute unit power of muscle pump ejection and suction (NE, and NS, MPa/min) were calculated and compared with the arterial blood supply of the lower extremity (LBF, L/min).

Results: ΔP demonstrated a consistent pattern of changes during walking and running. In GSV, the ΔP was observed to be directed from the thigh to the mid-calf (retrogradely) and from the ankle to the mid-calf (anterogradely) throughout the entire stride cycle. However, its value decreased with increasing stride cycle frequency. The dynamics of ΔP between the IV and GSV were as follows: It was directed from the IV to GSV during gastrocnemius contraction and was reversed during anterior tibial muscle contraction and gastrocnemius relaxation (swing phase). LBF, NE, and NS demonstrated similar exponential growth with increasing stride frequency during walking and running.

Conclusions: During natural locomotion, the muscle pump acts as a flow diverter pump, redirecting the flow of blood from the superficial veins to the intramuscular veins via the perforating veins. During ambulation, the pressure in the superficial venous network depends upon the capacity of the muscle pump to provide output that matches the changes in arterial blood flow.

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人的小腿肌肉泵具有分流泵的功能,可在运动过程中维持较低的活动静脉压力。
目的:活动静脉压(AVP)是指小腿浅静脉在运动过程中出现的压力下降。这种现象与小腿肌肉泵(CMP)的功能和静脉瓣膜的能力有关。然而,关于小腿肌肉泵功能的概念仍存在争议。本研究旨在阐明健康受试者在不同类型和强度的运动中,小腿肌肉活动、不同静脉段压力变化和下肢动脉供血之间的关联:研究对象为 9 名健康志愿者的 12 条腿。在跑步机上行走、跑步和跖屈运动时记录连续压力(肌内静脉[IV]和三个大隐静脉[GSV]点)和表面肌电图数据(腓肠肌和胫骨前肌[ATM])。计算相邻测量点之间的压力梯度(ΔP,毫米汞柱)。结果:ΔP 在步行和跑步过程中表现出一致的变化模式。在 GSV 中,观察到ΔP 在整个步幅周期内从大腿到小腿中部(逆行)以及从脚踝到小腿中部(顺行)。然而,其值随着步频的增加而降低。IV和GSV之间的ΔP动态变化如下:在腓肠肌收缩时,它从IV指向GSV,而在胫骨前肌收缩和腓肠肌放松时(摆动阶段)则相反。在步行和跑步过程中,随着步频的增加,LBF、NE 和 NS 显示出类似的指数增长:结论:在自然运动过程中,肌肉泵充当了血流分流泵的角色,通过穿孔静脉将血液从浅静脉流向肌肉内静脉。在行走过程中,浅静脉网络的压力取决于肌肉泵提供与动脉血流变化相匹配的输出量的能力。
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来源期刊
Journal of vascular surgery. Venous and lymphatic disorders
Journal of vascular surgery. Venous and lymphatic disorders SURGERYPERIPHERAL VASCULAR DISEASE&n-PERIPHERAL VASCULAR DISEASE
CiteScore
6.30
自引率
18.80%
发文量
328
审稿时长
71 days
期刊介绍: Journal of Vascular Surgery: Venous and Lymphatic Disorders is one of a series of specialist journals launched by the Journal of Vascular Surgery. It aims to be the premier international Journal of medical, endovascular and surgical management of venous and lymphatic disorders. It publishes high quality clinical, research, case reports, techniques, and practice manuscripts related to all aspects of venous and lymphatic disorders, including malformations and wound care, with an emphasis on the practicing clinician. The journal seeks to provide novel and timely information to vascular surgeons, interventionalists, phlebologists, wound care specialists, and allied health professionals who treat patients presenting with vascular and lymphatic disorders. As the official publication of The Society for Vascular Surgery and the American Venous Forum, the Journal will publish, after peer review, selected papers presented at the annual meeting of these organizations and affiliated vascular societies, as well as original articles from members and non-members.
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