Rapid Post Exercise Venous Refilling Time is an Independent Contributor to Chronic Venous Insufficiency.

Abstract

Background: Chronic venous insufficiency (CVI) results in complications such as pain, swelling, edema, skin changes, and ulcerations of the lower extremities. Valvular incompetence and venous obstruction are well-recognized contributors to CVI. Post-exercise venous refilling time (P-EVRT), the time to refill veins after calf muscle contractions during venous plethysmography study, is an understudied contributor to CVI.

Methods and results: In this cross-sectional study of 4,755 patients who were evaluated with venous air plethysmography, 9,510 lower limbs were categorized based on Post-Exercise Venous Refilling Time (P-EVRT) into two groups: rapid (< 20 seconds; n=5,256) and normal (n=4,254). Rapid P-EVRT was associated with higher mean CEAP scores (3.2 vs 2.5, p<0.001) and a higher prevalence of active/prior ulcers (11.6 vs 4.1%, p<0.001). Univariable analysis showed that age, male sex, the severity of incompetence, obstruction, calf pump function (CPF), and rapid P-EVRT were all significantly associated with active/prior ulcers. After multivariable adjustment for these significant factors, rapid P-EVRT was an independent contributor to active/prior ulcers (OR 1.44, 95% CI 1.17-1.77). Among limbs without other venous pathology by plethysmography (incompetence, obstruction, reduced CPF), rapid P-EVRT remained significantly associated with higher mean CEAP scores (p<0.001) and a higher prevalence of venous ulcers than limbs with normal P-EVRT (5.7 vs 2.7%, p=0.001).

Conclusions: In this large contemporary study using venous air plethysmography, we demonstrate that rapid post-exercise venous refilling is an important and unique venous physiologic parameter that informs our understanding of the clinical severity of CVI.