Accuracy of Venous Filling Index on Standing (VFIst) and Pure Regurgitation Index (PRI), a Novel Index Obtained by Air Plethysmography, for Detecting Venous Reflux

Abstract

Objective: To evaluate the accuracy of venous filling index on standing (VFIst) and a new index named pure regurgitation index (PRI), obtained by air plethysmography, for detecting venous reflux. Materials and Methods: One hundred and sixty-one healthy subjects (161 limbs) and 180 varicose vein patients (180 limbs) were investigated. All subjects underwent duplex ultrasonography for verifying venous reflux and air plethysmography to obtain hemodynamic parameters such as VFIst, VFI in the supine position (VFIsu), and the maximum arterial inflow rate. To evaluate the accuracy of VFIst and PRI (= (VFIst -VFIsu)/body mass index), receiver operating characteristics curves were created. Results: The optimal cut-off value, sensitivity, specificity, and area under the curve, obtained from analyzing the receiver operating characteristics curves, of VFIst vs. PRI were 2.058 mL/s vs. 0.059 mL ⋅ m 2 /s ⋅ kg, 93.3% vs. 90.3%, 88.8% vs. 91.3%, and 0.954 vs. 0.964, respectively. Conclusions: This study indicates that while both VFIst and PRI are highly accurate indicators of venous reflux, PRI, which is not affected by the arterial inflow rate and body mass index, is slightly superior to VFIst, especially in subjects with greater body mass index.Keywords: venous filling index, pure regurgitation index, accuracy, air plethysmography, varicose veins However, since VFIst is highly affected by the arterial inflow rate (AIR) and body mass index (BMI), 4) it seems an insufficient indicator for quantifying venous reflux. With this in mind, the aim of this study was to create an original index, termed pure regurgitation index (PRI), which is not affected by AIR and BMI, and to evaluate and compare the accuracy of VFIst and PRI as indicators of venous reflux. Materials and MethodsThe normal group (NG) analyzed in this study comprised 161 ambulatory patients (161 right limbs; 37 men and 124 women; mean age [range], 63.3 [22-88] years) who visited the Shiraishi Vascular Surgery Clinic with various leg complaints from May 2012 to February 2015. These patients underwent physical examination, APG, and duplex ultrasonography (DS) to exclude arterial or venous diseases. Arterial disease was ruled out by palpation of the posterior tibial artery and dorsalis pedis artery. The absence of superficial and deep vein incompetence was verified using DS. The mean (range) BMI of the subjects was 23.6 (15.4-33.8) kg/m 2 . The NG consisted of 32 patients who underwent varicose vein treatment for the left leg, 51 preoperative patients with saphenous type varicose vein in the left leg (no venous reflux in the right leg), 20 patients with orthopedic disease such as osteoarthritis, 33 patients experiencing leg dullness during standing work and evening edema, two patients with previous deep vein thrombosis in the left leg, 12 patients with metabolic syndrome, and 11 patients with only telangiectasias in the right leg. None of the patients had a history of deep vein thrombosis in the right leg.Another 180 patients with unilateral axial reflux in the great saph...

Venous hemodynamics assessed with air plethysmography in legs with lymphedema

“…6 Arterial inflow in limbs with lymphedema was reportedly increased [7][8][9] or unchanged. 10,11 Even if the increase is due to chronic low grade inflammation or excess fat accumulation, 12 the impact on the venous filling index should be limited compared to that derived from axial GSVR, as Shiraishi reported, 13 and as verified in the current study.…”