A noninvasive screening test to detect "critical" deep venous reflux

Harada, Russell N.; Katz, Mira L.; Comerota, Anthony J.

doi:10.1016/s0741-5214(95)70033-1

Cited by 34 publications

(26 citation statements)

References 18 publications

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“…59,60 Abnormal venous filling indices have excellent test characteristics to detect reflux (with sensitivity of 70% to 80% and positive predictive value of 99%) and have been found to correlate with the severity of CVI. [57][58][59][60] The function of the calf muscle pump in ejecting blood is determined after 1 and 10 repetitive contractions during toe raises. The volume of blood ejected with 1 tiptoe maneuver divided by the venous volume is called the ejection fraction.…”

Section: Air Plethysmographymentioning

confidence: 99%

“…Complications of CVI, including ulceration, have been shown to correlate with the severity of venous disease assessed with the venous filling index and ejection capacity. 47,56,59 This technique provides quantitative information about several aspects of global venous function and may be used in the selection of intervention and assessment of the response to intervention. 61,62 APG may be clinically useful when the venous duplex does not provide definitive information on the pathophysiology of CVI, especially in C 3 through C 6 , as recommended in the CPG (grade 1B).…”

Section: Air Plethysmographymentioning

confidence: 99%

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Chronic Venous Insufficiency

2014

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Section: Air Plethysmographymentioning

confidence: 99%

Section: Air Plethysmographymentioning

confidence: 99%

Chronic Venous Insufficiency

2014

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“…A normal venous filling index is Ͻ2 mL/s, whereas higher levels (Ͼ4 to 7 mL/s) have been found to correlate with the severity of CVI. 44,45 The venous filling index may be the best parameter in the detection of abnormal reflux, with a sensitivity of 70% to 80% and positive predictive value of 99%. 43 The ability of the calf muscle pump to eject blood is determined after a single and 10 repetitive contractions during toe raises.…”

Section: Air Plethysmographymentioning

confidence: 99%

“…Complications of CVI, such as ulceration, have been shown to correlate with the severity of reflux assessed with the venous filling index and ejection capacity. 32,42,44 This technique provides quantitative information about several aspects of global venous function. It may be used in the selection of intervention and assessment of the response to intervention.…”

Section: Air Plethysmographymentioning

confidence: 99%

Chronic Venous Insufficiency

2005

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C hronic venous disease is often overlooked by primary and cardiovascular care providers because of an underappreciation of the magnitude and impact of the problem. The importance of chronic venous disease is related to the number of people with the disease and the socioeconomic impact of its more severe manifestations. Unfortunately, the literature concerning the prevalence and incidence of chronic venous disease has varied greatly because of differences in the methods of evaluation, criteria for definition, and the geographic regions analyzed. The most common manifestations of chronic venous disease are dilated cutaneous veins, such as telangiectases and reticular veins, and varicose veins. The term chronic venous insufficiency (CVI) describes a condition that affects the venous system of the lower extremities with venous hypertension causing various pathologies including pain, swelling, edema, skin changes, and ulcerations. Although the term CVI is often used to exclude uncomplicated varicose veins, varicose veins have incompetent valves with increased venous pressure leading to progressive dilation and tortuosity. We will use the term CVI to represent the full spectrum of manifestations of chronic venous disease.Varicose veins have an estimated prevalence between 5% to 30% in the adult population, with a female to male predominance of 3 to 1, although a more recent study supports a higher male prevalence. 1 The Edinburgh Vein Study screened 1566 subjects with duplex ultrasound for reflux finding CVI in 9.4% of men and 6.6% of women, after age adjustment, which rose significantly with age (21.2% in men Ͼ50 years old, and 12.0% in women Ͼ50 years old). 2 The San Valentino Vascular Screening Project found among the 30 000 subjects evaluated by clinical assessment and duplex ultrasound a prevalence of 7% for varicose veins and 0.86% for "symptomatic" CVI. 3 As in previous studies, CVI was more common with increasing age, but there was no significant sex difference. The rate of varicose vein development may be estimated from the Framingham Heart Study, which found an annual incidence of 2.6% in women and 1.9% in men. 4 Risk factors found to be associated with CVI include age, sex, a family history of varicose veins, obesity, pregnancy, phlebitis, and previous leg injury. 5,6 There also may be environmental or behavioral factors associated with CVI such as prolonged standing and perhaps a sitting posture at work. 6,7 Varicose veins have a significant impact on healthcare resources, with millions of people seeking medical attention for their cosmetic appearance annually. Although often minimized, the cosmetic consequences may adversely affect an individual's quality of life and are associated with other manifestations.The more serious consequences of CVI such as venous ulcers have an estimated prevalence of Ϸ0.3%, although active or healed ulcers are seen in Ϸ1% of the adult population. 8 It has been estimated that Ϸ2.5 million people have CVI in the United States, and of those, Ϸ20% develop venous ulcers. 9 The ov...

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“…São métodos simples, não-invasivos e reprodutíveis na avaliação da hemodinâmica venosa dos membros inferiores 3,5 . Os dados avaliados por meio da pletismografia a ar são quantitativos tanto para o refluxo valvular como para a função de bomba muscular da panturrilha, enquanto o mapeamento dúplex 16 avalia os mesmos dados, porém mostra detalhes anatômicos, de forma qualitativa e em segmentos com refluxo e obstrução 17 .…”

Section: Discussionunclassified

Avaliação da bomba muscular da panturrilha em pacientes portadores de varizes primárias dos membros inferiores através da pletismografia a ar

et al. 2007

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ResumoObjetivo: Avaliar a influência do refluxo das veias musculares da panturrilha (surais e geniculares) na função da bomba muscular da panturrilha em pacientes com varizes primárias nos membros inferiores.Métodos: Estudo transversal prospectivo, no qual os pacientes foram avaliados por meio de exame físico, mapeamento dúplex e pletismografia a ar. Foram selecionados 120 pacientes divididos em dois grupos (60 indivíduos em cada). O primeiro grupo apresentava refluxo das veias musculares da panturrilha e o segundo grupo apresentava ausência de refluxo. Cada grupo foi analisado com pletismografia a ar para estudo da função da bomba da panturrilha. As variáveis estudadas foram fração de ejeção, fração do volume residual, volume ejetado e índice de enchimento venoso para membro inferior direito e esquerdo. Resultados:No grupo com refluxo, índices de fração de ejeção abaixo de 60% (com p < 0,001) foram encontrados em 82,3% (em perna esquerda) e em 74,6% (em perna direita) dos casos. Índices de fração do volume residual acima de 60% foram identificados em 62,5% (em perna esquerda, p = 0,015) e em 86,7% (em perna direita, p = 0,014) dos casos avaliados. Não houve variação estatisticamente significativa para o índice de enchimento venoso entre os grupos com e sem refluxo, com p = 0,140 e p = 0,140 para pernas esquerda e direita, respectivamente. Foram encontrados 63,6% dos pacientes com refluxo das veias da panturrilha (em perna esquerda), e 61,8% (em perna direita) com volume ejetado acima de 150 mL (p = 0,001). Conclusões:Houve alteração da bomba muscular da panturrilha, levando a uma diminuição de sua função, em ambos os membros inferiores por conseqüência da presença do refluxo das veias musculares da panturrilha (geniculares e surais). Palavras-chave:Pletismografia a ar, bomba muscular da panturrilha, varizes, veias gastrocnêmias e soleares, mapeamento dúplex. AbstractObjective: This article aims at assessing the influence of calf muscle vein reflux (sural and genicular veins) on calf muscle pump function in patients with primary varicose veins of the lower limbs. Methods:Cross-sectional and prospective study assessing 120 patients divided into two groups (60 subjects each) by physical examination, duplex scan and air plethysmography. The first group showed calf muscle venous reflux, whereas the second group presented absence of reflux. Both groups were examined by air plethysmography to verify calf pump function through measurement of ejection fraction, residual volume fraction, ejected volume and venous filling index in both limbs. Results:In the group of patients with reflux, ejection fraction indexes lower than 60% (p < 0.001) were found in 82.3% (left leg) and 74.6% (right leg) of cases. Levels of residual volume fraction greater than 60% were identified in 62.5% (left leg, p = 0.015) and in 86.7% (right leg, p = 0.014) of assessed cases. There was no statistically significant variation concerning the venous filling index between groups with or without reflux, with p = 0.140 in both legs. Of all patients, 63...

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A noninvasive screening test to detect "critical" deep venous reflux

Cited by 34 publications

References 18 publications

Chronic Venous Insufficiency

Chronic Venous Insufficiency

Chronic Venous Insufficiency

Avaliação da bomba muscular da panturrilha em pacientes portadores de varizes primárias dos membros inferiores através da pletismografia a ar

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