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Online ISSN 1827-1766
Lattimer C. R. 1, 2, Kalodiki E. 1, 2, Azzam M. 2, Geroulakos G. 1, 2
1 Imperial College, London, UK;
2 Ealing Hospital, Middlesex, UK
Aim. A Valsalva manoeuver (VM) like coughing, getting up or the strain occurring during stocking application are all events which may occur following foam sclerotherapy. The aim of this study was to measure the haemodynamic effects of a standardised VM within an incompetent great saphenous vein (GSV).
Methods. Twenty-three patients (23 legs), median age 45 years (range 23-78), median GSV diameter 7.5 mm (IQR 1.9) awaiting endovenous treatment underwent a VM in the supine position. Time averaged mean velocity (TAMV), peak velocity (PV) and terminal GSV diameter were measured using ultrasound, during three seconds of straining followed by three seconds of relaxation.
Results. Four patients had no reflux with 1 patient unable to perform the VM. In the remaining 18 patients during the strain phase the median (IQR) calculated GSV area, PV and calculated displaced volume was 56.1 mm2 (30.1), 47.8 cm/s (30.3) and 24.9 mL (30.6), respectively. In the recovery phase the corresponding measurements were 43.6 mm2 (21.9), -18.4 cm/s (-18) and -9.2 mL (-9.9). There was significantly more blood displaced during reflux than during recovery (median 24.9 mL vs. -9.2 mL, P<0.0005, Wilcoxon).
Conclusion. These results demonstrate that a VM causes significant haemodynamic effects where bolus foam displacement into deep veins and blood-foam mixing may occur. Patients should avoid all activities which may cause a VM. A pre-applied below knee stocking may be of benefit. A VM may hamper the safety and efficacy of foam sclerotherapy. Patients should remain still and calm during and immediately after treatment.