venous blood flow - what is normal?

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venous blood flow - what is normal?

Postby thisisalex » Tue Jul 13, 2010 2:18 pm

There are a few doctors in my country willing to start the diagnostics. They have read the Zamboni materials, and understand the effects of a NOT normal blood flow in the veins.
Now, they would like to have papers about the parameters of a NORMAL venous blood flow. They want to have an independent paper about what is normal in the upper venous system. They told me its not really researched... but it is needed in order to get a green light

Could someone please referring me to a paper like that?

thank you very much!
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Postby Cece » Tue Jul 13, 2010 2:37 pm

I'm not turning up much, tell me if this is of any use?

http://radiographics.rsna.org/content/1 ... l.pdf+html

Normal venous anatomy and collateral pathways in upper extremity venous thrombosis.
H M Richard, 3rd, J B Selby, Jr, S B Gay and C J Tegtmeyer

This is the full text of the article.

Or maybe this one:
Doppler ultrasonography of normal neck veins
Alain Pucheu, MD 1 *, John Evans, MD 2, Daniel Thomas, PR 3, Claude Scheuble, MD 4, Marie Pucheu, MD 1

http://www3.interscience.wiley.com/jour ... 6/abstract

Doppler ultrasonography was used to examine 198 neck-vein systems (67 right, 131 left) in 148 patients. The vessel lumen is usually echo-free: the veins are supple, and the internal jugular and sometimes the subclavian veins can be compressed. The venous confluence is Y-shaped. Blood flow was symmetrical and biphasic in 57% of cases, continuous in 29% of cases, and monophasic in 13% of cases. Blood flow velocity was less than 1 m/s in all cases and varied with respiration and heart rate. Color Doppler allows flow imaging and increases the speed and reliability of the procedure. This investigation is useful for following-up patients with indwelling venous catheters and is the investigation of choice whenever pathology of the neck veins is suspected. © 1994 John Wiley & Sons, Inc.


and a third:
http://www.informaworld.com/smpp/conten ... a789982639

Retrograde Venography of the Internal Jugular Veins and Transverse Sinuses: Technique and roentgen anatomy
Authors: Tomas Gejrotab; Tore Laurnab
Affiliations: a Department of Oto-rhino-laryngology, Karolinska Sjukhuset, Stockholm 60, Sweden
b Central Department of Diagnostic Radiology, Karolinska Sjukhuset, Stockholm 60, Sweden

Abstract
A detailed description of the technique of retrograde jugularography and of the normal variations of the transverse sinus and internal jugular vein is given. The value of the method for preoperative examination of the venous drainage from the brain is discussed. The variations of the contours of the upper part of the internal jugular vein are described and the usefulness of retrograde jugularography in diagnosing tumours in or around the jugular foramen is emphasized.
"However, the truth in science ultimately emerges, although sometimes it takes a very long time," Arthur Silverstein, Autoimmunity: A History of the Early Struggle for Recognition
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Postby thisisalex » Tue Jul 13, 2010 2:54 pm

Cece wrote:I'm not turning up much, tell me if this is of any use?

http://radiographics.rsna.org/content/1 ... l.pdf+html

Normal venous anatomy and collateral pathways in upper extremity venous thrombosis.
H M Richard, 3rd, J B Selby, Jr, S B Gay and C J Tegtmeyer

This is the full text of the article.


Thank you Cece, but it looks like a paper about an abnormal venous system, because it is about collateral pathways.

I need a paper which is useful for ultrasound imaging. It should be about the normal parameters of the veins, like:
what diameter is normal for the IJVs?
what is the amount of blood which is normal (cm/sec... whatever) ?
what speed is normal for the flow?
is it normal to have a stenosis in healthy people?
is it normal to have collaterals?

my doctors need it, because Zamboni only defines what is NOT normal. But does anyone researched ever, what is normal?
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Postby Cece » Tue Jul 13, 2010 2:57 pm

I think the second one I listed could be it?

Doppler ultrasonography of normal neck veins
Alain Pucheu, MD 1 *, John Evans, MD 2, Daniel Thomas, PR 3, Claude Scheuble, MD 4, Marie Pucheu, MD 1

http://www3.interscience.wiley.com/jour ... 6/abstract
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Postby AlmostClever » Tue Jul 13, 2010 3:02 pm

Along those lines...

What are normal diamter range sizes of the jugular veins? Internal and external?

I know in hydraulics, there is only a certain amount of fluid you can move through a pipe size under a certain pressure..don't know how that applies here...

And what about overall cross sectional area of each and all combined?

I have read that abnormally large externals (maybe bigger than 7 mm predict smaller than average internal jglars (maybe less than 8-10 mm) but nowhere have I been able to find what the average sizes of these veins are... (i can doc this but i'm too lazy....)

Can anyone shed some more light on this as it applies to this thread?
If you can't explain it simply, you don't understand it well enough. - Al Einstein
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Postby Cece » Tue Jul 13, 2010 3:07 pm

J Ultrasound Med. 1990 May;9(5):261-5.

Internal jugular venous flow measurement by means of a duplex scanner.
Müller HR, Hinn G, Buser MW.

*Department of Neurology, University of Basel, Switzerland.

Abstract
Using a special probe holder, cross-sectional area and time-averaged mean spatial velocity of the internal jugular vein were measured by means of a duplex scanner and multiplied to calculate volume flow. In a cohort of 100 subjects ages 21 to 70 years, average right plus left flow was 740 +/- 209 mL/min. Flow was 8.7% lower in females than in males. Normalization of flow to 100 g brain tissue by dividing it through the mean sex specific brain weight resulted in no significant sex difference. Within the age range investigated, there was no decrease of flow with age.

http://www.ncbi.nlm.nih.gov/pubmed/2188005

*************************************

Vasa. 1990;19(1):26-9.

[Doppler sonography measurement of jugular vein blood flow]
[Article in German]

Brunhölzl C, Müller HR.

Neurologische Universitätsklinik, Kantonsspital Basel.

Abstract
By multiplying mean cross section determined with a linear array scanner by time averaged mean spatial velocity measured with a single gated pw Doppler device, internal jugular venous volume flow was computed in 50 healthy male and 50 female volunteers aged 21 to 70 years with even age distribution within this range. Right plus left flow was 793 +/- 276 ml/min in males and 799 +/- 288 ml/min in females. There was no correlation between flow and age.

PMID: 2188457 [PubMed - indexed for MEDLINE]

http://www.ncbi.nlm.nih.gov/pubmed/2188457
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Postby Cece » Tue Jul 13, 2010 3:13 pm

Ultrasound Med Biol. 2007 Apr;33(4):500-5.

Flow volume in the jugular vein and related hemodynamics in the branches of the jugular vein.
Chung CP, Hsu HY, Chao AC, Wong WJ, Sheng WY, Hu HH.

Section of Neurovascular Diseases, Neurological Institute, Veterans General Hospital-Taipei, Taipei, Taiwan.
Abstract
Venous reflux in the internal jugular vein branches (JB) was found frequently in patients of certain neurologic disorders. We hypothesized that the retrograde-flow in JB is associated with retrograde hypertension transmitted from the internal jugular vein (IJV), which presumably underlies those neurologic disorders. In this study, we used color-Doppler imaging to evaluate the dynamic venous flow patterns in the IJV and its branches in 50 normal individuals (21 men, 29 women; mean age: 40.9 +/- 14.9 y, range: 22 to 70 y). The flow-direction of all detected JB (n = 100) was flowing into the IJV at baseline. During the Valsalva maneuver (VM), 38 JB (38%) had a retrograde-flow. Retrograde-flow in JB was significantly associated with IJV valve incompetence (OR = 7.6; 95% CI = 2.6 to 21.8; p = 0.0002) and greater IJV blood flow volume (blood flow volume >670 mL/min) (OR = 6.6; 95% CI = 1.8 to 24.5; p = 0.0052), both of which may reflect higher IJV pressure transmission during VM. The sonographic findings can be used in the future studies of diseases that are suspected to be related with retrograde cerebral venous hypertension due to an elevated IJV venous pressure.


PMID: 17337108 [PubMed - indexed for MEDLINE]

http://www.ncbi.nlm.nih.gov/pubmed/17337108

This one talks about reflux and neurological disorders, but it is a study only on healthy patients.
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Postby ikulo » Tue Jul 13, 2010 4:11 pm

Cece wrote:Or maybe this one:
Doppler ultrasonography of normal neck veins
Alain Pucheu, MD 1 *, John Evans, MD 2, Daniel Thomas, PR 3, Claude Scheuble, MD 4, Marie Pucheu, MD 1

http://www3.interscience.wiley.com/jour ... 6/abstract

Doppler ultrasonography was used to examine 198 neck-vein systems (67 right, 131 left) in 148 patients. The vessel lumen is usually echo-free: the veins are supple, and the internal jugular and sometimes the subclavian veins can be compressed. The venous confluence is Y-shaped. Blood flow was symmetrical and biphasic in 57% of cases, continuous in 29% of cases, and monophasic in 13% of cases. Blood flow velocity was less than 1 m/s in all cases and varied with respiration and heart rate. Color Doppler allows flow imaging and increases the speed and reliability of the procedure. This investigation is useful for following-up patients with indwelling venous catheters and is the investigation of choice whenever pathology of the neck veins is suspected. © 1994 John Wiley & Sons, Inc.



How does this finding (that IJVs can be compressed) factor into everything?
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Postby AlmostClever » Tue Jul 13, 2010 4:51 pm

Image

Compressed jug?
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Postby Cece » Tue Jul 13, 2010 5:34 pm

Yeah, I'm not sure what is doing the compressing? CTOS?

Here's another one that talks about normal vs abnormal, extravasal compression, and flow. Brachiocephalic is another name for the innominate vein, which runs for a very short stretch after the internal jugular veins meet the subclavian vein and before it reaches the superior vena cava (did I get that right?). From this Russian article, it would suggest that we don't want our innominate veins to be making a mu angle because that would reduce flow; this would be in addition to our already reduced flow because of the ccsvi.

Sorry that this is straying a bit from the research I'm actually trying to find, which is what was orginally asked for. There really isn't much out there on normal. This one was at least comparing these abnormalities to a normal group, so there might be info gleaned from that normal group. I wish I had access to the full articles of these.

[The study of cerebral venous blood flow disturbance peculiarity in the norm and under the extravasal compression of brachiocephalic veins with the use of magnetic resonance venography and ultrasound duplex scanning]

MEDLINE

Semenov SE, Abalmasov VG

Vestn Rentgenol Radiol ; :13-7.

Abstract
The MR-venography of the veins and brain venous sinuses, brachiocephalic veins an internal jugular veins duplex scanning have been performed in order to study the distinctions of cerebral venous hemodynamics of healthy people and the patients with venous encephalopathy caused by the extravasal compression of the brachiocephalic veins at the neck level and the superior sections of mediastinum. It has been revealed that the blood flow reducing in transverse brain sinuses occurs not only in the case of outflow disorder in the distal sections of the venous system, but also in norm. This reducing depends on anatomic constitution of confluens sinuum and the venous angle type of brachiocephalic veins. The three venous angle types of brachiocephalic veins have been distinguished: y-type, mu-type and Y-type. It has been registered that in case of the mu-type angle the blood flow can be reduced in norm due to peripheral resistance increase at the physiological bends of nearly a right angle type. The distinctions of hemodynamics in case of venous obstruction in contrast to arterial obstruction have been described. It has been registered that in case of outflow trouble in one of the internal jugular veins the speed and the volume of the blood flow in it are progressively reduced depending on the duration and the manifestation of compression. All this results in narrowing of the vein diameter from the affected side, and in compensatory distention of the diameter and increase of blood flow volume in the contralateral internal jugular vein, vertebral and external jugular veins, in succession.


two more possibles: Müller HR, Casty M, Buser M, Haefele M (1988 ). "Ultrasonic jugular venous flow measurement. " J Cardiovasc Ultrasonogr 7 : 25-29 .

Müller HR, Hinn G, Buser MW (1990 ). "Internal jugular venous flow measurement by means of a duplex scanner. " J Ultrasound Med 9 : 261-265 .
"However, the truth in science ultimately emerges, although sometimes it takes a very long time," Arthur Silverstein, Autoimmunity: A History of the Early Struggle for Recognition
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Postby thisisalex » Wed Jul 14, 2010 5:05 am

Cece

Thank you very much for your great work! The second link is something i was looking for. I appreciate your work!
you gave me some great ideas and I have researched PubMed to find more papers like that.
Just for the record I collected all the papers I and you have found in a pdf file:
http://ccsvi.blog.hu/media/file/UH_normal.pdf

these are all about a normal venous flow

thanks again :)
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Postby Cece » Wed Jul 14, 2010 7:53 am

Thanks, I downloaded the pdf. I think it's an important question: what is normal? Because that will help define what is abnormal. And it is commonly accepted that what is abnormal gets treated.
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