Advertisement
Original communication| Volume 109, ISSUE 5, P567-574, May 1991

Volume tests for chronic venous insufficiency: An appraisal

      This paper is only available as a PDF. To read, Please Download here.

      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.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Schanzer H
        • Peirce II, EC
        A rational approach to the chronic venous stasis syndrome.
        Ann Surg. 1982; 195: 25-29
        • Ackroyd JS
        • Browse NL
        The investigation and surgery of the post-thrombotic syndrome.
        J Cardiovasc Surg. 1986; 27: 5-15
        • Jessup G
        • Lane RJ
        Repair of incompetent venous valves: a new technique.
        J Vasc Surg. 1988; 8: 569-575
        • Schanzer H
        • Schwartz M
        • Teodorescu V
        • et al.
        Treatment of primary valvular incompetence by external splinting.
        in: Proceedings of the Twelfth Annual Congress of the Phlebology Society of America, Kansas City, Mo., May 19–201989: 75-83
        • Browse NL
        • Burnand KG
        • Thomas ML
        Diagnoses of the veins: pathology, diagnosis and treatment. Chapter 4. Techniques of investigation.
        in: Edward Arnold, Baltimore1988: 71-72
        • Browse NL
        • Burnand KG
        • Thomas ML
        Diagnoses of the veins: pathology, diagnosis and treatment. Chapter 4. Techniques of investigation.
        in: Edward Arnold, Baltimore1988: 85-100
        • Mason R
        • Giron F
        Noninvasive evaluation of venous function in chronic venous disease.
        Surgery. 1982; 91: 312-317
        • Fernandes E
        • Fernandes J
        • Horner J
        • Needham T
        • Nicolaides A
        Ambulatory calf volume plethysmography in the assessment of venous insufficiency.
        Br J Surg. 1979; 66: 327-330
        • Christopoulos D
        • Nicolaides AN
        Noninvasive diagnosis and quantitation of popliteal reflux in the swollen and ulcerated leg.
        J Cardiovasc Surg. 1988; 29: 535-539
        • Abramowitz HB
        • Queral LA
        • Flinn WR
        • et al.
        The use of photoplethysmography in the assessment of venous insufficiency: a comparison to venous pressure measurements.
        Surgery. 1979; 86: 434-441
        • Norris CS
        • Beyrau A
        • Barnes RW
        Quantitative photoplethysmography in chronic venous insufficiency: a new method of noninvasive estimation of ambulatory venous pressure.
        Surgery. 1983; 94: 758-764
        • Kempczinski RF
        • Berlatzky Y
        • Pearce WH
        Semi-quantitative photoplethysmography in the diagnosis of lower extremity venous insufficiency.
        J Cardiovasc Surg. 1986; 27: 17-23
        • Norgren L
        Foot volumetry before and after surgical treatment of patients with varicose veins.
        Acta Chir Scand. 1975; 141: 129-134
        • Vasdekis SN
        • Clarke GH
        • Nicolaides MS
        Quantitation of venous reflux by means of duplex scanning.
        J Vasc Surg. 1989; 10: 670-677
        • Schanzer H
        • Lande L
        • Premus G
        • Peirce II, EC
        Noninvasive evaluation of chronic venous insufficiency: use of foot mercury strain-gauge plethysmography.
        Arch Surg. 1984; 119: 1013-1017
        • Peirce II, EC
        • Premus G
        • Martinelli G
        • Schanzer H
        Foot blood flow measurements improve venous plethysmographic studies.
        Surgery. 1987; 101: 422-429
        • Peirce II, EC
        • Schanzer H
        Arterial flow in venous volume studies.
        Mount Sinai J Med. 1989; 56: 41-45
        • Barendsen GJ
        • van den Berg J
        Venous capacity, venous refill time and the effectiveness of the calf muscle pump in normal subjects.
        Angiology. 1984; 35: 163-172
        • Schanzer H
        • Younis C
        • Train J
        • Peirce II, EC
        Therapeutic implications of phlebographic obstruction in chronic venous stasis.
        J Cardiovasc Surg. 1990; 31: 173-177