What is the role of muscle pump ejection fraction (MPEF) testing in the diagnosis of varicose veins and spider veins (telangiectasia)?

Updated: Sep 25, 2020
  • Author: Robert Weiss, MD; Chief Editor: William D James, MD  more...
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The MPEF test is used to detect failure of the calf muscle pump to expel blood from the lower leg.

MPEF results are highly repeatable but require a skilled operator to obtain clean meaningful tracings. The patient is asked to perform 10-20 tiptoes or dorsiflexions at the ankle, and the change in some physical parameter that reflects calf blood volume is recorded as the calf muscle is pumped.

In patients without varicose veins, 10-20 tiptoes or ankle dorsiflexions cause the venous capacitance circuit of the calf to be emptied.

In patients with muscle pump failure, severe proximal obstruction, or severe deep vein insufficiency, tiptoes or ankle dorsiflexions have little or no effect on the amount of blood remaining within the calf.

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