Femoral Vein Pulsatility Signals Right-sided Cardiovascular Pathology: Implications for Echocardiographic Screening
Recommended Citation
Halabi M, Lee M, Chamseddine H, Shepard A, Nypaver T, Weaver M, Parikh S, Lee J, Shelters R, Kabbani L. Femoral Vein Pulsatility Signals Right-sided Cardiovascular Pathology: Implications for Echocardiographic Screening. J Vasc Surg Venous Lymphat Disord 2026; 14(2).
Document Type
Conference Proceeding
Publication Date
3-1-2026
Publication Title
J Vasc Surg Venous Lymphat Disord
Keywords
cardiovascular disease, conference abstract, controlled study, deep vein thrombosis, diagnosis, diagnostic value, echocardiography, female, femoral vein, heart right atrium pressure, human, lung artery pressure, male, predictive value, pulmonary hypertension, pulsatile flow, right atrial enlargement, right ventricular enlargement, tricuspid annular plane systolic excursion, tricuspid valve regurgitation
Abstract
Objective: Right-sided cardiovascular pathology (RCP) is often underdiagnosed. Femoral vein pulsatility (FVP) on venous duplex ultrasound (VDUS) examination may help diagnose RCP, but its diagnostic value and correlation with echocardiographic markers of RCP are not well-studied. Prior studies have associated FVP with elevated right-sided filling pressures, but there are limited data exploring its relationship to specific echocardiographic parameters and graded severity of RCP. This study was undertaken to evaluate the association between FVP and echocardiographic evidence of RCP. Methods: All patients who underwent lower extremity VDUS examination and concurrent echocardiography within 14 days between January 2020 and January 2024 at a quaternary medical center were reviewed. Patients with evidence of deep venous thrombosis and those with unilateral pulsatile flow were excluded. We defined FVP as cardiac pulsations detected during VDUS instead of low velocity phasic flow. RCP pathology was defined by at least one of the following on echocardiography: moderate or greater right ventricle (RV) enlargement, right atrial pressure of ≥10 mm Hg, moderate or greater tricuspid regurgitation (TR), moderate or greater RV dysfunction, moderate or greater pulmonary hypertension, or tricuspid annular plane systolic excursion (TAPSE) of ≤1.7 cm. Correlations between FVP and RCP were assessed using sensitivity, specificity, positive predictive value, negative predicative value, and χ2 test. Subgroup analyses were performed stratified by RCP status. Results: A total of 5223 patients with concomitant studies were identified, of whom 868 (15%) demonstrated FVP. RCP was present in 1367 patients. FVP demonstrated high specificity (92%) and a strong positive predictive value (83%) for RCP, although sensitivity was limited at 23%. Patients with FVP had 3.3 times higher odds of having RCP compared with those without pulsatility (odds ratio, 3.3; 95% confidence interval, 2.5-4.4). There was a significant trend in increasing FVP frequency with worsening right heart markers including increasing right atrial pressure, RV enlargement, RV dysfunction, greater TR, elevated pulmonary artery pressure, and decreasing TAPSE (Table). Conclusions: FVP was a common finding during VDUS in this patient population. FVP was found to be a specific, noninvasive marker of RCP, with strong correlations across multiple echocardiographic indicators of RCP. There was an increased frequency of FVP with worsening RCP.
Volume
14
Issue
2
