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You are right in that any bilateral pulsatility is an indicator of a more central problem such as CHF, tricuspid insufficiency, pulmonary hypertension.

 

Unilateral pulsatility is not seen with a pseudoaneurysm.  However other causes include:

Iatrogenic AV fistulae (like those seen with insitu bypasses)

Congenital AV fistulae

Traumatic AV fistulae

Of course if there is a dialysis graft or fistula in the limb

Also anything that will increase the arterial inflow to a limb will increase the venous outflow.  What goes in must come out.  Some time you can see increased venous flow which is slightly more pulsatile in a limb with infection or trauma (both of which will increase flow into the limb).

 


From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Cyndi Lufkin
Sent: Thursday, January 14, 2010 4:14 PM
To: [log in to unmask]
Subject: Re: Venous Pulsatility

 

Pulsatility from a cardiac origin would be bilateral in "normal" limbs.

CHF and Pulm HTN  are two primary reasons veins would be pulsatile.

Other cardiac pathologies could affect venous hemodynamics as well but these would be the most general ie: CHF or pulm htn secondary to severe valvular pathology.

 

If it is unilateral then there may be several explanations:  Ask yourself a few questions when and if that is noted:

1. Has the pt had any recent interventional procedures? 

2. Has AV Fistula been ruled out?
3. Has Pseudoaneurysm ruled out?

 

4. Is there proximal obstruction or extrinsic compression in the contralateral limb that is preventing the veins on that side from otherwise appearing pulsatile? 

 

flownetters: what can you add?


 


From: Barb B. Lemon <[log in to unmask]>
To: [log in to unmask]
Sent: Wed, January 13, 2010 12:32:55 PM
Subject: Venous Pulsatility

Does anyone have a reference that explains how one can find pulsatility in one lower extremity (CFV and GSV) and not the other? Is it clinically significant if found in only one limb of a bilateral exam?  Thanks for the brain power!

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