Presence of lower extremity venous pulsatility is NOT due to

cardiac dysfunction 

Introduction:  The presence of peripheral venous pulsatility is widely recognized and commonly attributed to cardiac dysfunction, however the precise cause(s) have been poorly defined in the literature.  We have noted multiple patterns of venous pulsatility, often in patients with no history of heart disease.  In a normal, high compliance venous system, cardiac pulsatility is continually dampened with distance from the heart.  We theorized that in a low compliance system, the pulsatility would be transmitted throughout and its presence is a reflection of the hemodynamic state of the lower extremity venous system.  

Methods:  We evaluated the right popliteal vein in 30 normal volunteers (average age 35) with no history of heart disease and minimal venous disease (C-Class range 0-2 average 0.4).  The right popliteal vein was chosen for its distal anatomic location and to avoid any potential of left iliac vein compression.  Three (3) spectral waveforms were obtained in the following manner:  1.) a left lateral supine position with the right popliteal vein at the level of the right atrium, 2.) after standing for >3” with no right leg weight bearing or muscle contraction, and 3.) following 10 seconds of vigorous plantar / dorsi flexion.   

Results:  In a supine position, all 30 limbs had normal respiratory phasicity with minor variation. In every patient, following quiet standing there was very low velocity forward flow with a discernable pulsatility. Immediately following dorsiflexion, flow became highly pulsatile.   

Conclusion: 100% of patients demonstrated a highly pulsatile flow when the lower extremity venous system was filled to resting hydrostatic pressure.  While cardiac dysfunction may result in venous hypertension reducing system compliance, the presence of pulsatile venous flow in the lower extremity can be demonstrated in all persons and is therefore solely a function of venous hemodynamics.