Validation of air plethysmography, photoplethysmography, and duplex ultrasonography in the evaluation of severe venous stasis

Bays, Ronald A.; Healy, Dean A.; Atnip, Robert G.; Neumyer, Marsha M.; Thiele, Brian L.

doi:10.1016/s0741-5214(94)70159-8

Cited by 111 publications

(76 citation statements)

References 19 publications

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“…The quantitative estimate of venous reflux provided by air plethysmography (APG), specifically the VFI, has proven useful pre-and postoperatively in assessing the results of therapy. 52,53 However, some limitations of these physiologic measurements have been expressed. 54,55 Pressure measurements are occasionally necessary in the evaluation of obstruction prior to or following deep vein reconstruction.…”

Section: Laboratory Evaluationmentioning

confidence: 99%

Primary chronic venous disorders

Meissner

Gloviczki

Bergan

et al. 2007

Journal of Vascular Surgery

166

159

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Primary chronic venous disorders, which according to the CEAP classification are those not associated with an identifiable mechanism of venous dysfunction, are among the most common in Western populations. Varicose veins without skin changes are present in about 20% of the population while active ulcers may be present in as many as 0.5%. Primary venous disorders are thought to arise from intrinsic structural and biochemical abnormalities of the vein wall. Advanced cases may be associated with skin changes and ulceration arising from extravasation of macromolecules and red blood cells leading to endothelial cell activation, leukocyte diapedesis, and altered tissue remodeling with intense collagen deposition. Laboratory evaluation of patients with primary venous disorders includes venous duplex ultrasonography performed in the upright position, occasionally supplemented with plethysmography and, when deep venous reconstruction is contemplated, ascending and descending venography. Primary venous disease is most often associated with truncal saphenous insufficiency. Although historically treated with stripping of the saphenous vein and interruption and removal of major tributary and perforating veins, a variety of endovenous techniques are now available to ablate the saphenous veins and have generally been demonstrated to be safe and less morbid than traditional procedures. Sclerotherapy also has an important role in the management of telangiectasias; primary, residual, or recurrent varicosities without connection to incompetent venous trunks; and congenital venous malformations. The introduction of ultrasound guided foam sclerotherapy has broadened potential indications to include treatment of the main saphenous trunks, varicose tributaries, and perforating veins. Surgical repair of incompetent deep venous valves has been reported to be an effective procedure in nonrandomized series, but appropriate case selection is critical to successful outcomes.

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Section: Laboratory Evaluationmentioning

confidence: 99%

Primary chronic venous disorders

Meissner

Gloviczki

Bergan

et al. 2007

Journal of Vascular Surgery

166

159

View full text Add to dashboard Cite

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“…58,59 In the diagnosis of venous reflux, duplex scanning has been shown to be superior to descending venography in correlating with the degree of venous reflux as measured by foot volumetry and with the clinical severity of disease as determined by clinical examination. [60][61][62][63] Duplex scanning is 84% sensitive and 88% specific in the diagnosis of deep venous insufficiency as compared with direct venous pressure measurements and venous filling times. 64 Arterial disease needs to be considered when evaluating patients with lower extremity ulcers.…”

Section: Diagnostic Testingmentioning

confidence: 99%

Chronic Venous Insufficiency and Venous Ulceration

Alguire

Mathes

1997

J Gen Intern Med

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OBJECTIVE:To review and summarize the literature on the normal venous circulation of the leg, and the epidemiology, pathophysiology, and treatment of chronic venous insufficiency (CVI).DATA SOURCES: English-language articles identified through a MEDLINE search using the terms venous insufficiency or varicose ulcer and epidemiology, pathophysiology, diagnosis, and clinical trial (pt), and selected cross-references. STUDY SELECTION:Articles on epidemiology, pathophysiology, and treatment of CVI. Randomized, controlled studies were specifically sought for treatment efficacy. DATA EXTRACTION:Data were manually extracted from selected studies and reviews; emphasis was placed on information relevant to the general internist. pproximately 5 million people in the United States exhibit some evidence of chronic venous insufficiency (CVI) and between 400,000 and 500,000 of these individuals have or will develop a venous leg ulcer. 1-3 The signs of CVI include engorgement of the cutaneous veins and dependent edema in mildly affected patients to pigmentation, dermatitis, and ulceration in the more severe cases. Although most patients are asymptomatic, others have leg heaviness and aching or recurrent and recalcitrant leg ulcers punctuated by bouts of cellulitis. These more severe cases are associated with recurrent hospitalization, high health-care costs, and disability. 4,5 Venous insufficiency with trophic skin changes or ulceration is a frustrating problem, which many physicians approach with a sense of ennui. This may be due to the chronic and remitting nature of the problem, the need for lifestyle modification, inconvenient therapies, and contradictory information regarding medical and surgical management. Nevertheless, CVI, including ulceration, is a manageable problem. The purpose of this review is to present the normal anatomy and physiology of the venous circulation and to summarize the epidemiology, pathophysiology, and treatment of CVI. DATA SYNTHESIS: METHODSA MEDLINE search for relevant English-language articles published between 1966 and 1996 was completed using the following MeSH terms: venous insufficiency or varicose ulcer and epidemiology, pathophysiology, diagnosis, and clinical trial (pt). When selecting articles on treatment, randomized, controlled trials were reviewed whenever possible. Emphasis was placed on reviewing articles with clinical relevance for internal medicine physicians. ANATOMY AND NORMAL PHYSIOLOGYVenous blood from the skin and subcutaneous fat is collected in a system of superficial venules and veins that drain toward the deep venous system underneath the fascia via three major pathways: (1) through the long or short saphenous veins, which join the deep system at the saphenofemoral and saphenopopliteal junctions; (2) through the perforating veins originating from the long or short saphenous veins or their branches; or (3) directly into the deep venous system or bypass the deep system entirely and enter the pelvis. 6 Deep veins are categorized as either intramuscular or intermuscular; o...

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“…Because of the inability of the light to penetrate deeply through the skin, difficulties in calibration, and poor specificity, these techniques have little current application in venous disease. 114 Venous obstruction. Physiological roles of the lower extremity venous system include adjustment to changes in circulating blood volume and central hemodynamics by accumulation and release of additional volumes of blood.…”

Section: Chronic Venous Diseasementioning

confidence: 99%

The hemodynamics and diagnosis of venous disease

Meissner

Moneta

Burnand

et al. 2007

Journal of Vascular Surgery

312

233

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The venous system is, in many respects, more complex than the arterial system and a thorough understanding of venous anatomy, pathophysiology, and available diagnostic tests is required in the management of acute and chronic venous disorders. The venous system develops through several stages, which may be associated with a number of development anomalies. A thorough knowledge of lower extremity venous anatomy, anatomic variants, and the recently updated nomenclature is required of all venous practitioners. Effective venous return from the lower extremities requires the interaction of the heart, a pressure gradient, the peripheral muscle pumps of the leg, and competent venous valves. In the absence of pathology, this system functions to reduce venous pressure from approximately 100 mm Hg to a mean of 22 mm Hg within a few steps. The severe manifestations of chronic venous insufficiency result from ambulatory venous hypertension, or a failure to reduce venous pressure with exercise. Although the precise mechanism remains unclear, venous hypertension is thought to induce the associated skin changes through a number of inflammatory mechanisms. Several diagnostic tests are available for the evaluation of acute and chronic venous disease. Although venous duplex ultrasonography has become the standard for detection of acute deep venous thrombosis, adjuvant modalities such as contrast, computed tomographic, and magnetic resonance venography have an increasing role. Duplex ultrasonography is also the most useful test for detecting and localizing chronic venous obstruction and valvular incompetence. However, it provides relatively little quantitative hemodynamic information and is often combined with measurements of hemodynamic severity determined by a number of plethysmographic methods. Finally, critical assessment of venous treatment modalities requires an understanding of the objective clinical outcome and quality of life instruments available.

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Validation of air plethysmography, photoplethysmography, and duplex ultrasonography in the evaluation of severe venous stasis

Cited by 111 publications

References 19 publications

Primary chronic venous disorders

Primary chronic venous disorders

Chronic Venous Insufficiency and Venous Ulceration

The hemodynamics and diagnosis of venous disease

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