Plethysmography as a Method for the Functional Evaluation of Venous Reflux and Obstruction Associated with Chronic Venous Disease

Plethysmography as a method for studying peripheral circulatory system was first proposed by wletney in 1953. In Russia, the first most significant research studies on the feasibility of plethysmography in studying peripheral blood flow and circulatory physiology taken together were conducted at the St. Petersburg Pavlov Institute of Physiology in 1961. From this time onwards, the possibilities of plethysmography as a non-invasive objective method for the diagnosis of hemodynamic disorders, particularly in arterial pathology, were studied intensively. These parameters were not determined for the venous blood flow, but in 1980s the authors were able to establish plethysmographic criteria not only for various forms of venous pathology, but also for degrees of chronic venous insufficiency using a device significantly improved by V.N. Pavlov and V.E. Maslov.The purpose of this publication is to analyze the literature data on the use of aerial plethysmography and photoplethysmography in the study of hemodynamic disorders in patients with chronic diseases of the veins of the lower extremities. At present, in order to assess the venous blood flow in condition of air plethysmography, indicators of functional venous volume (VV), maximum venous outflow (MVO), venous filling index (VFI), evacuation volume (EV) and residual volume (RV), as well as an integral indicator – residual volume fraction (RVF) are determined in the world. A venous reflux test (VRT) is performed as part of photoplethysmography. The data published today show the high statistical reliability of the comparative analysis and the great scientific significance of the research. According to many foreign authors the use of plethysmographic methods of diagnosis allow to assess violations of venous blood flow in patients with chronic venous diseases of various clinical classes according to CEAP more precisely and to give a global assessment of disorders of the venous outflow from thrombotic occlusion of segmental to hypervolemia in patients with varicose veins in different forms of manifestations of chronic venous insufficiency. The analysis of the literature data allows to make a conclusion about the prospects of further research using these non-invasive methods of evaluation of venous blood flow in the lower extremities.

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Photoplethysmographic characteristics of the efficiency of the calf muscle-venous pump in norm and in patients with cvd of various clinical classes according to CEAP

Шайдаков

Sannikov²

2021

Ambulatornaya khirurgiya

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Introduction. A literature review on the use of plethysmographic methods for studying the features of venous blood flow in lower extremities under physiological conditions and for global assessment of venous hemodynamics in chronic venous diseases urges to conduct further studies.The aim of the study was to carrying off a detailed statistical analysis of the value of the refilling time (RT) obtained during a photoplethysmographic study (PPG) to evaluate the degree of effectiveness of the calf muscle-venous pump in normal and in patients of different clinical classes according to CEAR.Materials and methods. For the period from 2002 to 2012, 116 healthy individuals with no symptoms of chronic venous diseases and 530 patients with CVD were examined with the use of PPG, with their distribution in accordance with the CEAR international classification as follows: C0-C1 – 140 people (26.42%), C2-C3 – 218 people (41.13%) and 172 persons (32.45%) had trophic disorders, that is, they belonged to the C4-C6 clinical classes. The analysis of the statistical significance of the obtained mathematical characteristics in groups by conducting a t-test for two independent samples calculated by the program and the student’s criterion Z-statistics, to conduct a correlation analysis.Results and discussion. Statistical comparative analysis of the RT value as a result of the t-test at the significance level p < 0,05 showed statistically significant differences between С0-С1, С2-С3 and С4-С6 groups with test with (or no) compression cuff. A stable correlation of average strength was observed between the groups in all cases. The differences were not statistically significant between the Norm and C0-C1 groups. The testing hypotheses for adequacy using linear regression methods allowed us to conclude that conducting a photoplethysmographic examination of patients with CVD of different clinical classes as part of the venous reflux test can provide objective information about the effectiveness of the calf muscle - venous pump. A comparative analysis in groups using the criteria RT > 20 sec and 10 < RT < 20 sec showed that there was no correlation between many groups.Conclusion. PPG is not a universal tool for diagnosing disorders of venous hemodynamics in the lower extremities. The value of RT > 20 seconds can be used as a criterion for evaluating the effectiveness of the calf muscle-venous pump, since more than 70% of cases occur in norm and in patients with C0-C1 clinical classes.

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Plethysmography as a Method for the Functional Evaluation of Venous Reflux and Obstruction Associated with Chronic Venous Disease

Cited by 4 publications

References 11 publications

Pharmacological Correction of Venous Reflux before Surgical Treatment of Varicose Veins

Pharmacological Correction of Venous Reflux before Surgical Treatment of Varicose Veins

Review of the plethysmographic methods for studying hemodynamic disorders in patients with chronic lower extremites venous diseases

Photoplethysmographic characteristics of the efficiency of the calf muscle-venous pump in norm and in patients with cvd of various clinical classes according to CEAP

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