Tauraginskii Roman A, Lurie Fedor, Simakov Sergei, Agalarov Rishal, Khramtsov Pavel, Babushkin Maxim, Gurina Tatiana, Borsuk Denis
Research Laboratory of Venous Hemodynamics, Phlebocenter LLC, Kaliningrad, Russia.
Jobst Vascular Institute, Toledo, OH; Division of Vascular Surgery, University of Michigan, Ann Arbor, MI.
J Vasc Surg Venous Lymphat Disord. 2025 Jan;13(1):101996. doi: 10.1016/j.jvsv.2024.101996. Epub 2024 Oct 22.
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.
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 (N, and N, MPa/min) were calculated and compared with the arterial blood supply of the lower extremity (LBF, L/min).
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, N, and N demonstrated similar exponential growth with increasing stride frequency during walking and running.
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.
动态静脉压（AVP）是在运动过程中观察到的小腿浅静脉压力下降。这一现象与小腿肌肉泵（CMP）的功能及静脉瓣膜的功能有关。然而，CMP功能的概念仍存在争议。本研究旨在阐明健康受试者在各种类型和强度的运动过程中，小腿肌肉活动、不同静脉段压力变化与下肢动脉血液供应之间的关联。
招募9名健康志愿者的12条腿参与本研究。在跑步机行走、跑步和跖屈运动过程中，记录连续压力（肌内静脉[IV]和三个大隐静脉[GSV]点）及表面肌电图数据（腓肠肌和胫前肌[ATM]）。计算相邻测量点之间的压力梯度（ΔP，mmHg）。计算肌肉泵射血和抽吸的每分钟单位功率（N和N，MPa/min），并与下肢动脉血液供应（LBF，L/min）进行比较。
在行走和跑步过程中，ΔP呈现出一致的变化模式。在大隐静脉中，在整个步幅周期内，观察到ΔP从大腿指向小腿中部（逆行），从脚踝指向小腿中部（顺行）。然而，其值随着步幅周期频率的增加而降低。IV和GSV之间ΔP的动态变化如下：在腓肠肌收缩期间，ΔP从IV指向GSV，而在胫前肌收缩和腓肠肌放松（摆动期）期间则相反。在行走和跑步过程中，随着步频增加，LBF、N和N呈现出相似的指数增长。
在自然运动过程中，肌肉泵起到分流泵的作用，通过穿通静脉将血液从浅静脉重新导向肌内静脉。在行走过程中，浅静脉网络中的压力取决于肌肉泵提供与动脉血流变化相匹配输出的能力。
