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You also see high venous flow in cellulitis Jason Sent from MARS -------- Original message -------- Subject: Re: High peripheral venous flow associated with narcotics From: Bill Schroedter <[log in to unmask]> To: [log in to unmask] CC: Hi Joe, I read your post with interest. I am quite certain that I cannot add any insight to the cause behind your observations but many years ago I had the opportunity to scan a couple patients who had been hospitalized for Vibrio infections. A quick overview - Vibrio infections are largely classified into two distinct groups: Vibrio cholera infections and noncholera Vibrio infections. Historically, the noncholera Vibrio species are classified as halophilic or nonhalophilic, depending on their requirement of sodium chloride for growth. Most Vibrio infections are associated with the consumption of contaminated food, these infections are often considered a foodborne disease. The prevalence of noncholera Vibrio infections in the United States appears to have increased in recent years largely due to increased water temperature and salinity where shellfish are harvested may contribute to increased contamination rates of shellfish. However these patients had limb infections, one who had had a wound which became infected after swimming in the Gulf of Mexico and the other with a known immunosupressed condition after cutting his foot on an oyster shell. Of course, I was called to rule out a DVT - what else. Clearly no DVT but the patients of course did have a hyperemic arterial flow with lots of diastolic flow as would be expected with the infection but also noted a very high venous flow as well. I did find many (dozens) of clearly identifiable but small arteriovenous fistulas throughout the limb, mostly in the lower leg and around the ankle. I surmised this was the cause of the higher than expected venous flow. I had the opportunity to re-scan these patients several times over their 1-2 week hospitalization and the number and size of these fistulas grew and then slowly disappeared as the infection cleared. I never had good explanation as to the cause. Bill William B Schroedter, BS, RVT, RPhS, FSVU Technical Director, Quality Vascular Imaging, Inc 4120 Woodmere Park Blvd Suite 8B Venice, Florida 34293 (941) 408-8855 office [log in to unmask] -----Original Message----- From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Joe Swenson Sent: Tuesday, October 02, 2012 6:26 PM To: [log in to unmask] Subject: High peripheral venous flow associated with narcotics 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. To unsubscribe or search other topics on UVM Flownet link to: http://list.uvm.edu/archives/uvmflownet.html To unsubscribe or search other topics on UVM Flownet link to: http://list.uvm.edu/archives/uvmflownet.html