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Venous Pooling

Edema and Venous Pooling

Lymphedema and Venous Pooling

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Edema and Venous Pooling

Related Terms: venous return, deep venous thrombosis, blood clot, venous stasis, chronic venous insufficiency, leg edema, syncope, orthostatic stress,  vasoconstriction of arterioles, post phlebitic syndrome, post thrombotic syndrome, Postural Tachycardia Syndrome, venous leg ulcer, venous congestion, lymphedema, venous reflux

Discussion

Increase in blood contained in veins of lower limbs occurring on standing. Results in fall in pulse pressure and consequential baroreflex increase in heart rate and vasoconstriction of arterioles. Putting it in layman's terms it is simply a poor return of the blood from the legs and feet to the heart. One resulting complication is edema of the affected limb. The edema results from fluid and plasma collecting within the limb instead of processing through the cardiovascular system. 

Venous pooling occurs due to lack of sympathetic activity and loss of active muscle function in the lower extremities and trunk musculature in persons with a spinal cord injury. This produces a smaller venous blood return to the heart, thus reducing stroke volume and cardiac output. To decrease this effect during exercise, an abdominal binder can be worn. This produces increased intra-abdominal pressure to help prevent redistribution of blood to the abdomen and lower extremities. This, in turn, helps prevent orthostatic hypotension (a sudden drop in systolic blood pressure greater than 20 mm Hg or a drop in diastolic blood pressure greater than 10 mm Hg resulting in nausea, dizziness, or fainting when in an upright position). The binder also helps with breathing.

Etiology

The main cause of this condition is the lack of, or damage to the bicuspid valves  in the veins.  In the normal pumping action of the heart blood flow is stopped from "backwashing" during the resting period of the heart from these valves.  When damaged or when congenitally not there, the blood flows backwards.  This can be either congenital or from trauma or disease.

Venous hypertension in diseased veins is thought to cause CVI by the following sequence of events. Increased venous pressure transcends the venules to the capillaries, impeding flow. Low-flow states within the capillaries cause leukocyte trapping. Trapped leukocytes release proteolytic enzymes and oxygen free radicals, which damage capillary basement membranes. Plasma proteins, such as fibrinogen, leak into the surrounding tissues, forming a fibrin cuff. Interstitial fibrin and resultant edema decrease oxygen delivery to the tissues, resulting in local hypoxia. Inflammation and tissue loss result. (1)

Another cause is Postural tachycardia syndrome (POTS).  This is a disorder that is characterized by a pulse rate that  is too high when the patient is standing.  Instead of the blood returning it pools due to the inefficient pump action of the heart. Symptoms of this disorder include rapid heartbeat, lightheadedness with prolonged standing, headache, chronic fatigue, chest pain, and other nonspecific complaints.

Finally, prolonged sitting in cramped position will cause venous pooling.  This is especially important to lymphedema patients.  On any prolonged trip, patients with this condition should make every effort to move around, stand, stretch or walk.

Symptoms

The most obvious symptom is the swelling that will occur in the foot and lower leg of the affected limb.  Other symptoms may include tight calves, legs and feet that feel "heavy," tired, achy or restless.

Treatment

Treatment for venous pooling will ultimately focus on the underlying condition that causes it.

For the edema involved, that patient may need decongestive massage therapy to gently move the fluids from the leg or foot.  Compression wrappings or compression hosery may be needed as well.

IIn the condition of the congenital lack of vein valves or in the situation of damaged vascular veins, surgical grafts may be required. Venous pooling is the accumulation of blood in the veins (of legs) due to  gravitational pull when a person changes position from lyinh down to standing up

Brief Definition:

Venous pooling is the accumulation of blood in the veins (of legs) due to  gravitational pull when a person changes
position from lyinh down to standing up
.

Because the veins are so much more pliable, due to a decrease in smooth muscle lining, they are capable of expanding without recoil to a grater extent. This property enables them to take an excess of 300-800ml of blood when a person stands up. Like all other systemic disturbances, it also affects a series of sensors of which the baro-receptors are all other systemic disturbances, it also affects a series of sensors of which the baro-receptors are the most important in this case. The decrease in blood flow/CO, stimulates the baro-recptors to compensate by increasing heart rate and vasoconstriction. This is meant to equalize pressure and flow defficiencies created by the lack of blood. Unfortunatelly, this system is very sensitive to external factors, such as temperature and pressure changes, which can cause significant changes in the response. For example, motion provides a quick alternative to restabilization of blood pressure and flow, since the muscles involved act as secondary pumping mechanisms for the venous surplus, moving it along. This also prevents edema in the legs, as the fluid pressure gradient is now equalized.

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Abstracts and Studies

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Reflex responses to regional venous pooling during lower body negative pressure in humans

Abstract

John R. Halliwill1, Lori A. Lawler1, Tamara J. Eickhoff1, Michael J. Joyner1 and Sharon L. Mulvagh2
1 Departments of Anesthesiology, Physiology, and Biophysics, Mayo Medical School, and 2 Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Foundation, Rochester, Minnesota 55905

http://jap.physiology.org/cgi/content/abstract/84/2/454

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Reflex responses to regional venous pooling during lower body negative pressure in humans

Abstract

http://www.uth.tmc.edu/apstracts/1997/jap/October/436A.html  

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Syncope (Fainting) - Venous Pooling

http://www.txai.org/edu/syncope/mechanisms.htm

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Capillaries, Veins and Venules, & Lymphatics

http://www.iuvascular.com/Unthank/Teach/Quiz2Answers.html

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Chronic Venous Insufficiency (1)

E Medicine

http://www.emedicine.com/med/topic2760.htm

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vein2.JPG (26933 bytes)The image on the right shows a cutaway section through a large vein

The vessels have a relatively large diameter (the vena cava is 2-3 cm in diameter) and thus offer low resistance to blood flow. Some veins, especially in the arms and legs, have internal folds of the endothelial lining that function as valves and allow blood to flow in one direction only, towards the heart. These valves can be damaged if over stretched by high venous pressures for long periods, for example during pregnancy or in people who stand for extended periods; the valves become incompetent, lose their function, and varicose veins develop. As a result of this, oedema and varicose ulcers can develop.

A major part of the blood volume, approximately 60%, is contained within the venous system and for this reason veins are sometimes referred to as capacity vessels. The capacity of the venous system can be modified by altering the lumen size of the muscular venules and veins; the changes are mediated by altering the venomotor tone, that is, the degree of contraction of the smooth muscle in the tunica media. Venomotor tone is mainly under the control of the sympathetic nervous system. Changes in the venomotor tone can increase or decrease the capacity of the venous circulation and therefore can partially compensate for variations in the effective circulating blood volume. 

Link no longer available

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http://www.nanomedicine.com/NMI/Figures/8.3.jpg

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See also:

Edema 

http://www.lymphedemapeople.com/wiki/doku.php?id=edema

Edema and Chronic Venous Insufficiency

http://www.lymphedemapeople.com/thesite/edema_chronic_venous_insufficiency.htm

Edema and Deep Venous Thrombosis

http://www.lymphedemapeople.com/thesite/lymphedema_deep_venous_thrombosis.htm

Edema and Reflex Sympathetic Dystrophy/Complex Regional Pain Syndrome

http://www.lymphedemapeople.com/thesite/edema_and_reflex_sympathetic_dystrophy.htm

Edema and Venous Pooling

http://www.lymphedemapeople.com/thesite/edema_and_venous_pooling.htm

Angioedema

http://www.lymphedemapeople.com/wiki/doku.php?id=angioedema

Edema of the Neck

http://www.lymphedemapeople.com/thesite/lymphedema_of_the_neck.htm

Edema and Nephrotic Syndrome

http://www.lymphedemapeople.com/thesite/edema_nephrotic_syndrome.htm

Edema of the Face

http://www.lymphedemapeople.com/thesite/edema_of_the_face.htm

Thrombophlebitis

http://www.lymphedemapeople.com/wiki/doku.php?id=thrombophlebitis

Edema and Diabetes

http://www.lymphedemapeople.com/thesite/lymphedema_and_diabetes.htm

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