The Value of Light Reflection Rheography for the Diagnosis of Superficial Venous Insufficiency: A Study in Patients with Primary Varicose Veins and in Workers with a Standing Occupation

Abstract

Objective: To study the value of light reflection rheography (LRR) as a diagnostic tool in subjects with varicose veins and venous insufficiency. Design: A prospective study comparing patients and workers with an occupation necessitating standing. Setting: Departments of Dermatology and Vascular Surgery, University Hospital VU, Amsterdam, The Netherlands and several manufacturing plants throughout the country. Subjects: Group I: 123 patients (168 legs) with a history of primary varicose veins attending the outpatient clinic; Group II: 374 male workers (748 legs) with an occupation necessitating standing. Methods: A questionnaire on venous disorders was administered, followed by clinical investigation, continuous-wave (c/w) Doppler ultrasound and LRR examination. LRR measurements were performed above the medial malleolus. A refilling time of at least 25 s after 10 dorsiflexions at the ankle was considered normal. In the case of shorter refilling times the procedure was repeated with a tourniquet above the probe. Normalization of the refilling time indicates an incompetent superficial venous system and a normal deep system. If there was no change we concluded deep venous insufficiency was present. Furthermore, in group I, duplex investigation of the venous system was performed. Main outcome measures: The diagnostic conclusions of the LRR measurements were compared with the diagnosis based on duplex investigation (group I) and clinical examination combined with c/w Doppler investigation (group II). Results: Group I: duplex investigation showed 156 cases of superficial venous insufficiency; LRR, 33. Sensitivity of LRR: 20%. Group II: Clinical and c/w Doppler examination showed 189 cases of superficial venous reflux; LRR, 29. Sensitivity of LRR: 7%. Conclusion: LRR has no apparent additive value in diagnosing superficial varicose veins in patients with a history of primary varicosities nor in screening a population for the presence of venous insufficiency.

Venous outflow and inflow resistance in health and venous disease

“…A number of investigators found the refilling time, which is the only quantitative parameter obtainable with standard photoplethysmography, to have a reasonable accuracy to detect VVI. [4][5][6][7][8][9][10][11][12] Some authors, however, found the current method still wanting because of the limited quantitative information obtained [13][14][15][16] and because possible venous obstructive disease cannot be diagnosed.…”