Calli,

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!

Joe.

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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