{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T17:14:30Z","timestamp":1789751670490,"version":"4.0.1"},"reference-count":23,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2025,2,10]],"date-time":"2025-02-10T00:00:00Z","timestamp":1739145600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Vasc Med"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>The calf muscle pump is an understudied contributor to venous return from the lower extremity. This study aimed to determine if calf pump function (CPF) is independently associated with the severity of chronic venous disease classified by CEAP (Clinical-Etiology-Anatomy-Pathophysiology).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>The Mayo Clinic Vascular Laboratory database was analyzed from January 2015 through September 2023. Ambulatory adults who underwent venous air plethysmography were included. Venous plethysmography assessed the severity of venous incompetence, and CPF was measured as ejection fraction (EF) per leg. The clinical component (C0 through C6) of the CEAP score was evaluated for each extremity at the time of the study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      A total of 7760 limbs from 3733 patients were analyzed. The mean age was 62 years, with 62% women. Venous obstruction was detected in 3.2% of limbs. Venous incompetence severity was categorized as normal (44%), mild (26%), moderate (19%), and severe (10%). A significant trend of reduced CPF was observed with higher CEAP scores (\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.001). Multivariable logistic regression, adjusted for age, sex, degree of venous incompetence, and obstruction showed reduced CPF was a significant predictor (odds ratio 1.84, CI: 1.5\u20132.2) of active\/prior ulcer (C5 or C6). In contrast to more severely reduced CPF, mildly reduced CPF (EF 40\u201349%) was not associated with active\/prior ulcers.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>This large contemporary study demonstrates that decreased CPF is associated with worse chronic venous disease. Importantly, we demonstrate for the first time that CPF is independently associated with active\/prior venous ulcers after accounting for other venous physiologic parameters and demographics.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/1358863x241311254","type":"journal-article","created":{"date-parts":[[2025,2,10]],"date-time":"2025-02-10T04:01:12Z","timestamp":1739160072000},"page":"473-479","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":8,"title":["Relationship between calf muscle pump function and severity of chronic venous disease"],"prefix":"10.1177","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8673-9783","authenticated-orcid":false,"given":"Atefeh","family":"Ghorbanzadeh","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Diseases, Division of Vascular Medicine, Mayo Clinic, Rochester, MN, USA"},{"name":"Gonda Vascular Center, Mayo Clinic, Rochester, MN, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Liedl","sequence":"additional","affiliation":[{"name":"Gonda Vascular Center, Mayo Clinic, Rochester, MN, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hossam","family":"Elbenawi","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Diseases, Division of Vascular Medicine, Mayo Clinic, Rochester, MN, USA"},{"name":"Gonda Vascular Center, Mayo Clinic, Rochester, MN, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thom","family":"Rooke","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Diseases, Division of Vascular Medicine, Mayo Clinic, Rochester, MN, USA"},{"name":"Gonda Vascular Center, Mayo Clinic, Rochester, MN, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Wennberg","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Diseases, Division of Vascular Medicine, Mayo Clinic, Rochester, MN, USA"},{"name":"Gonda Vascular Center, Mayo Clinic, Rochester, MN, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8727-8029","authenticated-orcid":false,"given":"Robert D","family":"McBane","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Diseases, Division of Vascular Medicine, Mayo Clinic, Rochester, MN, USA"},{"name":"Gonda Vascular Center, Mayo Clinic, Rochester, MN, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6065-9523","authenticated-orcid":false,"given":"Damon E","family":"Houghton","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Diseases, Division of Vascular Medicine, Mayo Clinic, Rochester, MN, USA"},{"name":"Gonda Vascular Center, Mayo Clinic, Rochester, MN, USA"},{"name":"Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,2,10]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1136\/jech.53.3.149"},{"key":"e_1_3_3_3_2","first-page":"105","article-title":"Epidemiology of chronic venous disorders in geographically diverse populations: Results from the Vein Consult Program","volume":"31","author":"Rabe E","year":"2012","unstructured":"Rabe E, Guex J, Puskas A, Scuderi A. Epidemiology of chronic venous disorders in geographically diverse populations: Results from the Vein Consult Program. Int Angiol 2012; 31: 105\u2013115.","journal-title":"Int Angiol"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0749-3797(18)31203-0"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.113.006898"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.mayocp.2023.08.013"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1177\/1358863X20953212"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1182\/blood.2020010231"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1177\/1358863X221124996"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2004.03.012"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbmt.2023.04.068"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1024\/0301-1526.38.2.171"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvsv.2024.101869"},{"key":"e_1_3_3_14_2","first-page":"299","article-title":"Calf muscle pump dysfunction in the patients with severe chronic venous insufficiency","volume":"47","author":"Simka M.","year":"2004","unstructured":"Simka M. Calf muscle pump dysfunction in the patients with severe chronic venous insufficiency. Phlebolymphology 2004; 47: 299\u2013303.","journal-title":"Phlebolymphology"},{"key":"e_1_3_3_15_2","first-page":"38","article-title":"Venous ulcers: Pathophysiology and treatment options","volume":"51","author":"Trent JT","year":"2005","unstructured":"Trent JT, Falabella A, Eaglstein WH, Kirsner RS. Venous ulcers: Pathophysiology and treatment options. Ostomy Wound Manage 2005; 51: 38\u201354; quiz 55\u201356.","journal-title":"Ostomy Wound Manage"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/0741-5214(94)90223-2"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/0741-5214(88)90406-5"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1111\/iwj.70040"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvsv.2013.10.053"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0741-5214(95)70030-7"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2011.01.079"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejvs.2020.09.023"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.1177\/1358863X13497637"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.1177\/1358863X251324106"}],"container-title":["Vascular Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/1358863X241311254","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/1358863X241311254","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/1358863X241311254","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T03:35:37Z","timestamp":1777692937000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/1358863X241311254"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,10]]},"references-count":23,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2025,8]]}},"alternative-id":["10.1177\/1358863X241311254"],"URL":"https:\/\/doi.org\/10.1177\/1358863x241311254","relation":{},"ISSN":["1358-863X","1477-0377"],"issn-type":[{"value":"1358-863X","type":"print"},{"value":"1477-0377","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,10]]}}}