Rapid post exercise venous refilling time is an independent contributor to chronic venous insufficiency

Chronic venous insufficiency (CVI) results in complications such as pain, swelling, edema, skin changes, and ulcerations of the lower extremities. Valvular incompetence and venous obstruction are well-recognized contributors to CVI. Post-exercise venous refilling time (P-EVRT), the time to refill veins after calf muscle contractions during venous plethysmography study, is an understudied contributor to CVI.

In this cross-sectional study of 4755 patients who were evaluated with venous air plethysmography, 9510 lower limbs were categorized based on P-EVRT into two groups: rapid (<20 seconds; n = 5256) and normal (n = 4254).

Rapid P-EVRT was associated with higher mean CEAP scores (3.2 vs 2.5; P < .001) and a higher prevalence of active/prior ulcers (11.6 vs 4.1%; P < .001). Univariable analysis showed that age, male sex, the severity of incompetence, obstruction, calf pump function, and rapid P-EVRT were all significantly associated with active/prior ulcers. After multivariable adjustment for these significant factors, rapid P-EVRT was an independent contributor to active/prior ulcers (odds ratio, 1.44; 95% confidence interval, 1.17-1.77). Among limbs without other venous pathology by plethysmography (incompetence, obstruction, reduced calf pump function), rapid P-EVRT remained significantly associated with higher mean CEAP scores (P < .001) and a higher prevalence of venous ulcers than limbs with normal P-EVRT (5.7% vs 2.7%; P = .001).

In this large contemporary study using venous air plethysmography, we demonstrate that rapid P-EVRT is an important and unique venous physiologic parameter that informs our understanding of the clinical severity of CVI.