Elastic compression treatment of chronic superficial venous insufficiency of the lower limbs based on Doppler venous pressure index measurements

Abstract

Ineffectiveness or discomfort from graduated elastic compression stockings (GES) in patients with chronic venous insufficiency (CVI) and/or varicose veins of the lower limbs (VVLL) can depend of inappropriate counter pressure applied. Counter pressure was calculated by Doppler venous pressure index (VPI). The aim of this study was to verify the value VPI in the choice of GES. A total of 1212 LL of 606 patients subjected to VPI measurements VPI correlated with the various sites of reflux (R) and C of Clinical-Etiology-Anatomy-Pathophysiology (CEAP) classification. The difference between standing VPI the and normal values=counter pressure to be applied by GES. Questionnaire to 96 patients with CVI/VVLL wearing GES. Mean VPI values: greater saphenous (GSV)>smaller saphenous; GSV with isolated venous reflux (R) at the leg>GSV at the thigh; additional R in perforators increases VPI in all the districts; superficial R increases VPI in PT. Relation between VPI/C of CEAP: P<0.05-0.0001; 81/83/96 (97.5%) patients improved; 0 complained. R in GSV at the leg and in perforators increases VPI in deep veins. Few discrepancies VPI/CEAP can be expected. Standing VPI is highly predictive. The best choice of GES can be based on the VPI measurement.

The Value of Doppler Venous Pressure Index in Chronic Venous Disease of the Lower Limbs

“…A significant correlation between VPI and the C of C.E.A.P. of every single limb was found and described in our previous paper [10] (P < 0.05 -0.0001).…”

“…This observation seems to confirm that the venous muscular pump efficiency can lead to normalization of the deep venous hypertension caused by an "overload syndrome", i.e., secondary to superficial R. During the previous experience, which is still in progress in our clinical practice, many advantages in the prophylactic and therapeutic project of every single patient were found. First of all, it seems to be quite reliable that patients with a well-defined CVI have thrombotic risk factors being increased in relation with the severity of the disease detected by the VPI values and not only by means of clinical judgment [10]. It seems also logical to divide the patients, who are candidate to surgical procedures for varicose veins of the LL, into different groups of priority on the basis of such risk factors.…”

“…Our experience also demonstrated that VPI does not always correspond to the clinical class of the disease. Therefore, it can be affirmed that such a parameter can easily make it possible to calculate the mean counter pressure necessary in every single limb and, consequently, to chose the more proper class of compression of elastic stockings more than by a simple clinical criterion [10].…”

“…We often decided where and how to extend superficial and/ or deep veins surgery and/or endovascular treatments, as endovenous laser and sclerotherapy of superficial venous insufficiency of the LL, for the patient's follow-up and for a more precise selection of the class of compression stockings [10], which rendered the patients more compliant than in the past [11], on the bases of the VPI results. The aim of this study was to verify the role and significance of the VPI measurements in the pathophysiology and diagnostics of superficial CVD of the LL and their clinical and therapeutic implications.…”

Causes and Treatment of Varicose Recurrence in the Popliteal Region

“…In five operated limbs (26.3%), a postoperative foam sclerotherapy and compression were performed after 2 months (Table 3). The compression class of the elastic stockings applied after surgery, sclerotherapy or in combination with drug therapy, was chosen on the basis of noinvasive venous pressure measurements [19,20].…”