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Abstract
Chronic venous disease is increasingly treated surgically with a variety of experimental
procedures. Noninvasive volume tests are commonly used before surgery to select patients
and after surgery to assess results. Rapid volume changes are considered to indicate
regurgitation. Rigorous statistical validation of tests and the confounding nature
of unmeasured arterial inflow are seldom considered. Volume changes were measured
in 29 control limbs and 35 limbs with venous disease, with mercury-in-silicone rubber
strain gauges, for both exercise and elevation. Normalization for arterial flow permitted
calculation of the regurgitation rate. Normal (95% confidence) limits for measured
and calculated parameters were determined. Specificity was shown by the percent of
normal parameter values for control limbs and sensitivity by the percent of abnormal
values for extremities with venous disease. Arterial flow significantly altered volume
curves. Normalization increased specificity and sensitivity significantly. Calf exercise
tests, even normalized, were too insensitive to be reliable. Elevation tests were
significantly more sensitive for determining regurgitation. However, exercise tests
were useful and supplied important information about the calf muscle pump. We conclude
that, as currently used, many limb volume test procedures are unsuitable but could
be improved significantly by normalization to reduce the confounding effect of regional
arterial flow and use of an elevation test to measure regurgitation.
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Article info
Publication history
Accepted:
August 20,
1990
Identification
Copyright
© 1991 Published by Elsevier Inc.
