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.
