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 The patients group 2 : Received the new Size and Expansibility of the Femoral Vein SEFV test... Principles on the Size and Expansion of the Femoral Vein SEFV test The first principl

New Management of

Orthostatic Hypotension

Thach Nguyen, Le Thi Thuy Linh

BACKGROUND

Current management of orthostatic hypotension :

 Increase salt and fluid intake

 Midodrine (A)

 Steroids (B)

 Knee or thigh high stocking (C)

There is no guideline or clinical clues when to use which and which combination

METHODS

Divided in 2 groups:

 Usual treatment (group 1) : Received the usual tests and

treatment

 The patients ( group 2 ) : Received the new Size and

Expansibility of the Femoral Vein (SEFV) test

Principles on the Size and Expansion of

the Femoral Vein (SEFV) test

The first principle:

 The volume of blood going through the femoral artery

and returning through the common femoral vein

should be the same

 The size of the femoral artery = the femoral vein

If the amount of venous return is lower

=> edema in the lower leg

The second principle:

 In VCS, the circulating blood about 65% in veins

but only 13% in arteries

 Size of arteries does not change much due to

vascular tone  keep a fairly constant blood

pressure (Figure 1)

Non-Invasive SEFV Test

 Measure the size and the expansion of the common

femoral vein

 Assess accurately the arterial and venous volume

 Examine the size of the femoral vein and its expansion

with cough

Figure 2 The location where

the probe positioned

Figure 3 Vascular probe

Figure 4 In patients with

normal fluid status

Figure 5 The size of the femoral vein is a little larger than the size of the common

femoral artery

Figure 6 Normal expansion of the femoral vein to less than 2 times larger than the baseline

Figure 7 In patient with pulmonary hypertension, dehydration or hypovolemia, there is no or minimal expansion of the femoral vein

Excessive Venous Pooling

Causing Syncope

Panel A The femoral

vein at its baseline

Panel B The femoral vein expanded to a huge volume upon cough

 15 patients - January 2015 to April 2016

 (10/15) arrived while on full dose of midodrine and

florinef

 8/15 patients –abnormal SEFV test - severe venous

pooling - improved well with thigh high ted hose

RESULTS

 Have the SEFV early + the results positive

=> Wear thigh high stocking

 Larger scale of clinical trial or registries are needed

Conclusion:

 Thach Nguyen[1], Advait Soni[1], Ryan Phan[2], Linh Thi Thuy Le[3], Tung Mai[4], Duane Pinto[5, 4]

 St Mary Medical Center, Hobart IN, USA

 Notre Dame University, South Bend IN, USA

 Tan Tao University Medical School, Long An,

Vietnam

 Detroit Medical Center, Detroit MI, USA

 Beth Israel Deaconess Medical Center, Boston MA, USA

References

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