Light Reflection Rheography and Thoracic Outlet Syndrome

Antignani, Pier Luigi; Pillon, Sergio; Fortunato, Tiziana; Bartolo, M

doi:10.1177/000331979004100505

Cited by 4 publications

(6 citation statements)

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“…The second one is a slow but ample component that mainly results from venous volume changes and can be obtained by applying a low-pass filter to the raw PPG signal (13,24,25). In patients with TOS, the high-pass filtered PPG signal (arterial pulsatility) has been largely studied (26)(27)(28)(29), whereas low-pass filtered PPG (venous PPG) has scarcely been studied (10,30). The specific interests of the Ca-Pra maneuver are to confirm whether venous emptying was impaired in abduction ("Ca" phase) and to change the semi-quantitative PPG technique (12) into a quantitative tool.…”

Section: Discussionmentioning

confidence: 99%

Quantitative analysis of venous outflow with photo-plethysmography in patients with suspected thoracic outlet syndrome

Hersant

Ramondou²,

Josse³

et al. 2022

Front. Cardiovasc. Med.

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BackgroundVenous compression is the second most frequent form of thoracic outlet syndrome (TOS). Although venous photo-plethysmography (PPG) has been largely used to estimate the consequences of chronic thromboses (Paget Schroetter syndrome), systematic direct quantitative recording of hemodynamic consequences of positional venous outflow impairment in patients with suspected TOS has never been reported.ObjectiveWe hypothesized that moving the arms forward (prayer: “Pra” position) while keeping the hands elevated after a surrender/candlestick position (Ca) would allow quantification of 100% upper limb venous emptying (PPGmax) and quantitative evaluation of the emptying observed at the end of the preceding abduction period (End-Ca-PPG), expressed in %PPGmax.Materials and methodsWe measured V-PPG in 424 patients referred for suspected TOS (age 40.9 years old, 68.3% females) and retrieved the results of ultrasound investigation at the venous level. We used receiver operating characteristics curves (ROC) to determine the optimal V-PPG values to be used to predict the presence of a venous compression on ultrasound imaging. Results are reported as a median (25/75 centiles). Statistical significance was based on a two-tailed p < 0.05.ResultsAn End-Ca-PPG value of 87% PPGmax at the end of the “Ca” period is the optimal point to detect an ultrasound-confirmed positional venous compression (area under ROC: 0.589 ± 0.024; p < 0.001). This threshold results in 60.9% sensitivity, 47.6% specificity, 27.3% positive predictive value, 79.0% negative predictive value, and 50.8% overall accuracy.ConclusionV-PPG is not aimed at detecting the presence of a venous compression due to collateral veins potentially normalizing outflow despite subclavicular vein compression during abduction, but we believe that it could be used to strengthen the responsibility of venous compression in upper limb symptoms in TOS-suspected patients, with the possibility of non-invasive, bilateral, recordable measurements of forearm volume that become quantitative with the Ca-Pra maneuver.Clinical trial registration[ClinicalTrials.gov], identifier [NCT04376177].

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Section: Discussionmentioning

confidence: 99%

Quantitative analysis of venous outflow with photo-plethysmography in patients with suspected thoracic outlet syndrome

Hersant

Ramondou²,

Josse³

et al. 2022

Front. Cardiovasc. Med.

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“…With low-pass filters, slow but ample changes associated to venous filling/emptying (V-PPG) become measurable. There have been some evaluations of V-PPG in upper limb thrombosis (Sullivan et al, 1983;Mukherjee et al, 1991), but, to the best of our knowledge, there is only one published case series of V-PPG in TOS in which limitations have been previously underlined (Antignani et al, 1990). The specific interest here is that we studied only the pattern of V-PPG changes, regardless of the amplitude of these changes, during a slightly modified candlestick maneuver to improve PPG results.…”

Section: Discussionmentioning

confidence: 99%

“…Various plethysmography techniques exist, among which photo-plethysmography (PPG) estimates the limb volume changes by measuring changes in light reflection at the skin level. Although venous PPG (V-PPG) has been used to study the hemodynamic consequence of upper limb thrombosis in Paget-Schroetter syndromes, reports of V-PPG use for positional venous investigations in non-complicated TOS are rare (Antignani et al, 1990). Since the observations of Antignani et al (1990) the hemodynamic consequences of the positional maneuvers in patients with suspected TOS have received little attention (Illig et al, 2013;Chen et al, 2014).…”

Section: Introductionmentioning

confidence: 99%

“…Although venous PPG (V-PPG) has been used to study the hemodynamic consequence of upper limb thrombosis in Paget-Schroetter syndromes, reports of V-PPG use for positional venous investigations in non-complicated TOS are rare (Antignani et al, 1990). Since the observations of Antignani et al (1990) the hemodynamic consequences of the positional maneuvers in patients with suspected TOS have received little attention (Illig et al, 2013;Chen et al, 2014). One reason for this is that PPG is a semiquantitative technique, leading to question the fact that during the candlestick maneuvers the volume decrease observed with PPG corresponded to completely emptied forearm veins during Abbreviations: A-PPG, arterial volume pulsatility plethysmography; AU, arbitrary units; Ca, "candlestick" position; DASH, disability of the arm and shoulder; PPG, photo-plethysmography; Pra, "prayer" position; TOS, thoracic outlet syndrome; V-PPG, venous photo-plethysmography.…”

Section: Introductionmentioning

confidence: 99%

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Forearm Volume Changes Estimated by Photo-Plethysmography During an Original Candlestick/Prayer Maneuver in Patients With Suspected Thoracic Outlet Syndrome

et al. 2021

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Objective: Hemodynamic investigations in thoracic outlet syndrome (TOS) remain difficult, even in trained hands. Results are generally reported as either presence or absence of venous compression. In fact, in patients with suspected TOS but without chronic venous occlusion, the forearm volume changes may result from various combinations of forearm position from heart level, arterial inflow, and/or venous outflow positional impairment.Design: Cross sectional, retrospective, single center study, accessible on Clinicaltrial.gov under reference NCT04376177.Material: We used venous photo-plethysmography (V-PPG) in 151 patients with suspected TOS. The subjects elevated their arms to the “candlestick” (Ca) position for 30 s and then kept their arm elevated in front of the body for an additional 15 s (“prayer” position; Pra). This CA–Pra procedure was repeated three times by each patient with recording of both arms.Method: We classified V-PPG recordings using an automatic clustering method.Result: The blinded clustering classification of 893 V-PPG recordings (13 missing files) resulted in four out of seven clusters, allowing the classification of more than 99% of the available recordings. Each cluster included 65.73, 6.16, 17.13, and 10.8% of the recordings, respectively.Conclusion: Venous hemodynamic profiles in TOS are not only either normal or abnormal. With V-PPG, four clusters were observed to be consistent with, and assumed to result from, the four possible associations of presence/absence of arterial inflow/venous outflow positional impairment: (1) normal response (maximal emptying in Ca and Pra), (2) isolated inflow impairment (emptying in Ca and filling in Pra due to post-ischemic vasodilation), (3) isolated venous outflow impairment (emptying then filling in Ca due to arterial inflow and emptying in Pra), and (4) simultaneous inflow/outflow impairment (emptying in Ca but no filling due to concomitant inflow impairment and further emptying in Pra).

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“…While there are many reports of arterial PPG from fingertip recording in TOS, at present, only one study in the 1980s proposed forearm V-PPG to estimate the presence or absence of venous outflow impairment ( Antignani et al, 1990 ). The enormous development and diffusion of US imaging is probably the major reason why V-PPG was not adopted in clinical routine in the last decades.…”

Section: Discussionmentioning

confidence: 99%

Thoracic Outlet Syndrome: Fingertip Cannot Replace Forearm Photoplethysmography in the Evaluation of Positional Venous Outflow Impairments

et al. 2021

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Objective: Fingertip photoplethysmography (PPG) resulting from high-pass filtered raw PPG signal is often used to record arterial pulse changes in patients with suspected thoracic outlet syndrome (TOS). Results from venous (low-pass filtered raw signal) forearm PPG (V-PPG) during the Candlestick-Prayer (Ca + Pra) maneuver were recently classified into four different patterns in patients with suspected TOS, two of which are suggestive of the presence of outflow impairment. We aimed to test the effect of probe position (fingertip vs. forearm) and of red (R) vs. infrared (IR) light wavelength on V-PPG classification and compared pattern classifications with the results of ultrasound (US).Methods: In patients with suspected TOS, we routinely performed US imaging (US + being the presence of a positional compression) and Ca + Pra tests with forearm V-PPGIR. We recruited patients for a Ca + Pra maneuver with the simultaneous fingertip and forearm V-PPGR. The correlation of each V-PPG recording to each of the published pattern profiles was calculated. Each record was classified according to the patterns for which the coefficient of correlation was the highest. Cohen’s kappa test was used to determine the reliability of classification among forearm V-PPGIR, fingertip V-PPGR, and forearm V-PPGR.Results: We obtained 40 measurements from 20 patients (40.2 ± 11.3 years old, 11 males). We found 13 limbs with US + results, while V-PPG suggested the presence of venous outflow impairment in 27 and 20 limbs with forearm V-PPGIR and forearm V-PPGR, respectively. Fingertip V-PPGR provided no patterns suggesting outflow impairment.Conclusion: We found more V-PPG patterns suggesting venous outflow impairment than US + results. Probe position is essential if aiming to perform upper-limb V-PPG during the Ca + Pra maneuver in patients with suspected TOS. V-PPG during the Ca + Pra maneuver is of low cost and easy and provides reliable, recordable, and objective evidence of forearm swelling. It should be performed on the forearm (close to the elbow) with either PPGR or PPGIR but not at the fingertip level.

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Light Reflection Rheography and Thoracic Outlet Syndrome

Cited by 4 publications

References 1 publication

Quantitative analysis of venous outflow with photo-plethysmography in patients with suspected thoracic outlet syndrome

Quantitative analysis of venous outflow with photo-plethysmography in patients with suspected thoracic outlet syndrome

Forearm Volume Changes Estimated by Photo-Plethysmography During an Original Candlestick/Prayer Maneuver in Patients With Suspected Thoracic Outlet Syndrome

Thoracic Outlet Syndrome: Fingertip Cannot Replace Forearm Photoplethysmography in the Evaluation of Positional Venous Outflow Impairments

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