Yes I had those same thoughts regarding the vasodilation and was left
wondering how this was occurring. It is interesting to see all superficial
veins, peforators, tibial and peroneal veins with 60-100 cm/sec velocities!


On Sat, Oct 6, 2012 at 7:39 PM, Calli opsis <[log in to unmask]> wrote:

> Narcotics like morphine and codeine typically have a vasodilation effect,
> which would in turn lower the flow state of the venous system and make it
> more difficult to get good waveforms in an extreme case.  I would think the
> body would compensate for any flow state with autoregulation, but I guess
> that is why some people get dizzy with narcotics (because they don't
> compensate).
> I wonder if their excessive drug use has caused LV dysvunction and even
> though they don't have a diagnosis of heart failure with CHF, maybe they
> have increased load?
> Very curious observation.  Certainly one that could result in a paper. :)
> On Tue, Oct 2, 2012 at 6:26 PM, Joe Swenson <[log in to unmask]> wrote:
>> I have observed, over several years, that patients using narcotic pain
>> medication or IV heroin users present with extermely high venous flow
>> states in the in the peripheral veins, both deep and superficial. Venous
>> duplex exams of these patients will produce extraordinarily high venous
>> velocities and significantly reduced phasicity within dilated Greater
>> Saph., Lesser Saph., perforators and tibial veins, which would typically
>> have nearly imperceptible spontaneous flow signals. This makes for
>> great color Doppler opportunities to clearly demonstarte every segment
>> of the tibial and peroneal vein anatomy. I am searching for information
>> that would reference and explain this type of venous vascular response
>> and the potential contribution to patients with venous insufficiency
>> signs and symptoms but without evidence of any area of reflux or other
>> obvious contributing factors. The impetus for this quandary was a
>> patient with a history of BLE hyperpigmentation, scleroderma, edema,
>> and episodes of LLE cellulitis. Duplex revealed only a single site of
>> minimal/trivial reflux. Medications included multiple long term narcotic
>> pain killers 3 years+, for leg pain. No CHF, obesity etc.
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