The Valve-Muscular Pump (MVP) of the lower limb, a kind of peripheral heart, is principally activated during walking, by the succession of gait phases. The pump has three parts, which work in a coordinated way. The foot pump, due to the compression of the predominating lateral plantar vein during the contact on the ground (40% of gait event), “eject” 20-30 cm3 of blood into the posterior tibial vein and, in alternative, in the anterior tibial, peroneal and saphenous veins connected by perforators. The distal calf pump, activated during dorsiflexion of the ankle (passive 20% and active 40% of gait event), when the calf muscles are stretched and their distal part descends within the fascial sheath. This movement acts like a piston which expels venous blood in proximal direction. The proximal calf muscle pump due to sural and gastrocnemius muscles rich in venous sinuses that are strongly squeezed during the impulse phase of the step. During dorsiflexion of the ankle (passive or active) space is given to the blood coming from the foot pump (due to weight bearing), that will feed in prevalence the posterior tibial veins. These two systems are “in series”: the foot pump cannot expel the blood into the deep veins if these are not regularly emptied. The proximal pump, at the opposite, is very strong and can void a high volume of blood in the popliteal vein, even in the absence of a favourable gradient as it works “in parallel”.
{"title":"Anatomy and venous hemodynamics of gait phases","authors":"S. Ricci","doi":"10.24019/jtavr.115","DOIUrl":"https://doi.org/10.24019/jtavr.115","url":null,"abstract":"The Valve-Muscular Pump (MVP) of the lower limb, a kind of peripheral heart, is principally activated during walking, by the succession of gait phases. The pump has three parts, which work in a coordinated way. The foot pump, due to the compression of the predominating lateral plantar vein during the contact on the ground (40% of gait event), “eject” 20-30 cm3 of blood into the posterior tibial vein and, in alternative, in the anterior tibial, peroneal and saphenous veins connected by perforators. The distal calf pump, activated during dorsiflexion of the ankle (passive 20% and active 40% of gait event), when the calf muscles are stretched and their distal part descends within the fascial sheath. This movement acts like a piston which expels venous blood in proximal direction. The proximal calf muscle pump due to sural and gastrocnemius muscles rich in venous sinuses that are strongly squeezed during the impulse phase of the step. During dorsiflexion of the ankle (passive or active) space is given to the blood coming from the foot pump (due to weight bearing), that will feed in prevalence the posterior tibial veins. These two systems are “in series”: the foot pump cannot expel the blood into the deep veins if these are not regularly emptied. The proximal pump, at the opposite, is very strong and can void a high volume of blood in the popliteal vein, even in the absence of a favourable gradient as it works “in parallel”.","PeriodicalId":17406,"journal":{"name":"Journal of Theoretical and Applied Vascular Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87550210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Invited commentary on 'The hemodynamic impact of the bidirectional flow within calf perforators and conductive veins in varicose vein disease', by C Recek","authors":"F. Passariello","doi":"10.24019/jtavr.102","DOIUrl":"https://doi.org/10.24019/jtavr.102","url":null,"abstract":"","PeriodicalId":17406,"journal":{"name":"Journal of Theoretical and Applied Vascular Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82322562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"In memory of Professor Waldemar Olszewski","authors":"Ningfei Liu","doi":"10.24019/jtavr.95","DOIUrl":"https://doi.org/10.24019/jtavr.95","url":null,"abstract":"","PeriodicalId":17406,"journal":{"name":"Journal of Theoretical and Applied Vascular Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76598111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Based on the historic reports about the life of Peregrine Laziosi (1265-1345) and a post-mortem examination 638 years after his death, the most probable diagnosis in this case was a venous ulcer on his right leg. As an act of penance, he did not lie down but stood in an upright position, praying to God for most of his adult life. Therefore he developed swollen legs and one extremity exulcerated. This is the typical story of a venous stasis ulcer. When the doctor came to amputate the leg the wound was healed (maybe due to excellent compression therapy performed by an angel, as demonstrated in many pictures and statues showing the miracle of St. Peregrine) (Canonization 1726). Cancer seems rather improbable based on the autopsy performed more than 600 years later and on the high age of Peregrine at his death. This case report from the middle ages is discussed concerning pathophysiology, prevention and therapy of stasis ulcers and some historic implications for todays practice are reported. Without any doubt St. Peregrine deserves more publicity, not only for the patients with leg ulcers, but also for the medical staff treating ulcer patients and how the fate of St. Peregrine can be prevented.
{"title":"How I met St Peregrine","authors":"Hugo Partsch","doi":"10.24019/jtavr.76","DOIUrl":"https://doi.org/10.24019/jtavr.76","url":null,"abstract":"Based on the historic reports about the life of Peregrine Laziosi (1265-1345) and a post-mortem examination 638 years after his death, the most probable diagnosis in this case was a venous ulcer on his right leg. As an act of penance, he did not lie down but stood in an upright position, praying to God for most of his adult life. Therefore he developed swollen legs and one extremity exulcerated. This is the typical story of a venous stasis ulcer. When the doctor came to amputate the leg the wound was healed (maybe due to excellent compression therapy performed by an angel, as demonstrated in many pictures and statues showing the miracle of St. Peregrine) (Canonization 1726). Cancer seems rather improbable based on the autopsy performed more than 600 years later and on the high age of Peregrine at his death. This case report from the middle ages is discussed concerning pathophysiology, prevention and therapy of stasis ulcers and some historic implications for todays practice are reported. Without any doubt St. Peregrine deserves more publicity, not only for the patients with leg ulcers, but also for the medical staff treating ulcer patients and how the fate of St. Peregrine can be prevented.","PeriodicalId":17406,"journal":{"name":"Journal of Theoretical and Applied Vascular Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84423112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Peripheral venous pressure is regulated by central and peripheral mechanisms. Peripheral venous hypertension is an important pathologic component of chronic venous disease and is present in about two-third of patients with chronic venous disease. It can result from reflux, obstructive lesions or high arterial inflow. The dominant influence in patients with peripheral venous hypertension appears to be obstruction rather than reflux. Reflux can be superficial or deep or both. In about 70% of patients with reflux, valvular incompetence is present in the superficial, deep and perforator systems in some combination. In an ex vivo experimental model, conduit pressure increased with smaller native or functional caliber, focal stenosis and increased post-capillary inflow. Venous pressure in the lower limb can be measured in a variety of ways: supine resting pressure, erect resting pressure and ambulatory venous pressure. These measurements are affected by factors such as intra-abdominal pressure, intra-thoracic pressure, gravity, venoarteriolar reflux, valve reflux and venous obstruction. Venous obstruction is associated with elevated supine pressures while reflux is associated with elevated erect resting and ambulatory venous pressures. Ambulatory venous pressure reflects venous hypertension in patients with advanced venous disease. However, our investigation has shown that ambulatory venous pressure hypertension is rarely present if air plethysmography testing is negative. Consideration maybe given to the omission of the ambulatory venous pressure testing if air plethysmography testing is normal.
{"title":"Pressure dynamics in chronic venous disease","authors":"T. Saleem, S. Raju","doi":"10.24019/jtavr.77","DOIUrl":"https://doi.org/10.24019/jtavr.77","url":null,"abstract":"Peripheral venous pressure is regulated by central and peripheral mechanisms. Peripheral venous hypertension is an important pathologic component of chronic venous disease and is present in about two-third of patients with chronic venous disease. It can result from reflux, obstructive lesions or high arterial inflow. The dominant influence in patients with peripheral venous hypertension appears to be obstruction rather than reflux. Reflux can be superficial or deep or both. In about 70% of patients with reflux, valvular incompetence is present in the superficial, deep and perforator systems in some combination. In an ex vivo experimental model, conduit pressure increased with smaller native or functional caliber, focal stenosis and increased post-capillary inflow. Venous pressure in the lower limb can be measured in a variety of ways: supine resting pressure, erect resting pressure and ambulatory venous pressure. These measurements are affected by factors such as intra-abdominal pressure, intra-thoracic pressure, gravity, venoarteriolar reflux, valve reflux and venous obstruction. Venous obstruction is associated with elevated supine pressures while reflux is associated with elevated erect resting and ambulatory venous pressures. Ambulatory venous pressure reflects venous hypertension in patients with advanced venous disease. However, our investigation has shown that ambulatory venous pressure hypertension is rarely present if air plethysmography testing is negative. Consideration maybe given to the omission of the ambulatory venous pressure testing if air plethysmography testing is normal.","PeriodicalId":17406,"journal":{"name":"Journal of Theoretical and Applied Vascular Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82236716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The bandage remains a very important instrument in daily phlebological practice, but making a good bandage is not always easy, especially in the presence of an unfavorable anatomy of the leg (inverted conical shape). One of the most common problems is the downward sliding of the bandages, which can also fold and create a lace effect. An anti-slip anchor, consisting of two turns of an acrylic glue bandage (this glue being practically hypoallergenic) or a cohesive bandage, placed below the knee, can help solving this inconvenience. This solution is very simple and effective according to the Authors' long-lasting experience. A clinical study on 50 patients confirms this efficacy.
{"title":"Anti-slip anchoring system for leg compression bandaging in phlebological practice","authors":"S. Ricci","doi":"10.24019/jtavr.125","DOIUrl":"https://doi.org/10.24019/jtavr.125","url":null,"abstract":"The bandage remains a very important instrument in daily phlebological practice, but making a good bandage is not always easy, especially in the presence of an unfavorable anatomy of the leg (inverted conical shape). One of the most common problems is the downward sliding of the bandages, which can also fold and create a lace effect. An anti-slip anchor, consisting of two turns of an acrylic glue bandage (this glue being practically hypoallergenic) or a cohesive bandage, placed below the knee, can help solving this inconvenience. This solution is very simple and effective according to the Authors' long-lasting experience. A clinical study on 50 patients confirms this efficacy.","PeriodicalId":17406,"journal":{"name":"Journal of Theoretical and Applied Vascular Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90187662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Tradition, common beliefs, and miracles, over science and understanding in chronic venous disease - The case of Saint Peregrine","authors":"N. Labropoulos","doi":"10.24019/jtavr.119","DOIUrl":"https://doi.org/10.24019/jtavr.119","url":null,"abstract":"","PeriodicalId":17406,"journal":{"name":"Journal of Theoretical and Applied Vascular Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74645701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Why do the saphenous vein varices arise? According to our concept this is a process of slow deconstruction of the vein wall by inflammation caused by microbes penetrating plantar skin, colonizing deep tissues, entering veins and sticking to valves, as well as, transported to lymphatics, bringing about damage to their wall and evoking immune response in the inguinal lymph nodes. Venous stasis caused by a variety of hemodynamic factors remains secondary to the primary damage of the vein wall. With respect to ulcer, irrespective of the predisposing factors as venous stasis, colonization of the denuded calf surfaces takes place by bacteria drained from foot skin and also those floating down to calf from the perineum. This set of microbes is responsible for progression of ulcer or its delayed healing. In this study, the numerical phenotypes of varicose veins and ulcer granulation tissue bacteria were presented. The dominant strains in the vein walls were Staph. epidermidis and aureus with Enterococci and Pseudomonas frequent in ulcers. High percentage of Staphylococci both in vein walls and ulcer sensitive to antibiotics may suggest that they originated from the microbiome inhabiting leg tissues prior to the development of varices and ulcer.
{"title":"Are bacteria the main pathological factor in pathogenesis of lower limb varicose veins and non-healing ulcers?","authors":"W. Olszewski, M. Zaleska, E. Stelmach","doi":"10.24019/jtavr.91","DOIUrl":"https://doi.org/10.24019/jtavr.91","url":null,"abstract":"Why do the saphenous vein varices arise? According to our concept this is a process of slow deconstruction of the vein wall by inflammation caused by microbes penetrating plantar skin, colonizing deep tissues, entering veins and sticking to valves, as well as, transported to lymphatics, bringing about damage to their wall and evoking immune response in the inguinal lymph nodes. Venous stasis caused by a variety of hemodynamic factors remains secondary to the primary damage of the vein wall. With respect to ulcer, irrespective of the predisposing factors as venous stasis, colonization of the denuded calf surfaces takes place by bacteria drained from foot skin and also those floating down to calf from the perineum. This set of microbes is responsible for progression of ulcer or its delayed healing. In this study, the numerical phenotypes of varicose veins and ulcer granulation tissue bacteria were presented. The dominant strains in the vein walls were Staph. epidermidis and aureus with Enterococci and Pseudomonas frequent in ulcers. High percentage of Staphylococci both in vein walls and ulcer sensitive to antibiotics may suggest that they originated from the microbiome inhabiting leg tissues prior to the development of varices and ulcer.","PeriodicalId":17406,"journal":{"name":"Journal of Theoretical and Applied Vascular Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86608126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Stasis ulcer is a chronic condition of combined venous and lymphatic insufficiency: Phlebo-lymphedema (PLE)","authors":"Byung-Boong Lee","doi":"10.24019/jtavr.79","DOIUrl":"https://doi.org/10.24019/jtavr.79","url":null,"abstract":"","PeriodicalId":17406,"journal":{"name":"Journal of Theoretical and Applied Vascular Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76480764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Saint Peregrine Laziosi of Forlì (1265–1345), healed in slumber by the Christ from a fatal leg lesion at the age of sixty, is considered in the Catholic tradition as the patron Saint of people suffering from incurable malignancies. On the basis of later sources relating his miraculous healing, both Roman Church and contemporary medical literature have hitherto endorsed various diagnostic interpretations of Saint Peregrine’s disease, either to ascertain its incurability and therefore the truthfulness of the miracle described by the sources, or, on the contrary, aiming to provide a complete naturalistic account of his lesion and instant healing. Albeit conflicting, both perspectives rest upon a literal reading of the available texts about Peregrine’s life. Medical scholarship on the subject, in particular, taking hagiographical reports as reliable sources to establish the ‘clinical’ truth of the matter, ends up neglecting the religious nature and the edifying purposes of extant written witnesses. I propose in this article to tackle this problem through a narratological lens, stressing on the literary templates and the medical terminology which shape the most ancient and authoritative report about Peregrine’s lower limb pathology. A retrospective diagnosis of venous varicosity complications may indeed appear convincing, although not beyond every doubt: notwithstanding its terminological accuracy, consistent with ancient and medieval medical accounts of infected leg ulcerations, this text builds strongly on a traditional scriptural and hagiographical background, ranging from the Old Testament and the Gospels to early Byzantine Lives of Saints. The impossibility to clearly distinguish the literate convention from the historical account prevents us from stating with certainty the originality of Peregrine’s pathological history, and hence the reliability of our sources as clinical reports.
{"title":"Peregrine’s sore. An analysis of the hagiographical reports on the leg disease of Saint Peregrine Laziosi of Forlì (1256–1345)","authors":"Sandro Passavanti","doi":"10.24019/jtavr.71","DOIUrl":"https://doi.org/10.24019/jtavr.71","url":null,"abstract":"Saint Peregrine Laziosi of Forlì (1265–1345), healed in slumber by the Christ from a fatal leg lesion at the age of sixty, is considered in the Catholic tradition as the patron Saint of people suffering from incurable malignancies. On the basis of later sources relating his miraculous healing, both Roman Church and contemporary medical literature have hitherto endorsed various diagnostic interpretations of Saint Peregrine’s disease, either to ascertain its incurability and therefore the truthfulness of the miracle described by the sources, or, on the contrary, aiming to provide a complete naturalistic account of his lesion and instant healing. Albeit conflicting, both perspectives rest upon a literal reading of the available texts about Peregrine’s life. Medical scholarship on the subject, in particular, taking hagiographical reports as reliable sources to establish the ‘clinical’ truth of the matter, ends up neglecting the religious nature and the edifying purposes of extant written witnesses. I propose in this article to tackle this problem through a narratological lens, stressing on the literary templates and the medical terminology which shape the most ancient and authoritative report about Peregrine’s lower limb pathology. A retrospective diagnosis of venous varicosity complications may indeed appear convincing, although not beyond every doubt: notwithstanding its terminological accuracy, consistent with ancient and medieval medical accounts of infected leg ulcerations, this text builds strongly on a traditional scriptural and hagiographical background, ranging from the Old Testament and the Gospels to early Byzantine Lives of Saints. The impossibility to clearly distinguish the literate convention from the historical account prevents us from stating with certainty the originality of Peregrine’s pathological history, and hence the reliability of our sources as clinical reports.","PeriodicalId":17406,"journal":{"name":"Journal of Theoretical and Applied Vascular Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82453585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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