Foot Venous Pressure Measurement in Patients with Varicose Veins

Abstract

For the evaluation of the severity of varicose veins, foot venous pressure (FVP) measurements utilizing manual calf compression were applied to 52 limbs with varicose veins (group V) and 12 limbs of healthy volunteers (group C). Group V was divided into three groups: group V1 comprising 37 limbs without stasis syndrome, group V2 comprising 9 limbs with pigmentation, and group V3 comprising 6 limbs with preulcerative or ulcerative skin change.

First, comparison of manual calf compression with the toe-stand test was performed, wherein a higher reproducibility was revealed for subjects undergoing manual calf compression. Also, a lower ambulatory venous pressure (AVP) and a higher percentage of FVP drop (%drop = [pressure at rest-AVP]/pressure at rest) was obtained with manual calf compression, confirming that this method apparently emptied the calf venous pool. Based on these findings, FVP at four seconds after compression (4SP) and its ratio of increase (4SR% = [4SP - AVP] / [pressure at rest - AVP]) were instituted by use of this method, in addition to AVP, % drop, and 50%/90% of calf-refilling times (RT50/RT90).

When the values of the four groups were compared, differences were insignificant between groups C and V1, while significant differences were found between groups V2 (continued on next page) (Abstract continued) or V3 and groups C or V1 in all parameters examined. The number of abnormal limbs that had values beyond the ranges for group C increased from group V1 to group V3. Such abnormalities were best revealed by 4SR% and RT50.

In the postoperative FVP measurements of 17 limbs, all parameters of all limbs were restored to the normal range, except for % drop of 4 limbs, and 4SR%, RT50, and RT90 of 1 limb.

Based on these findings, all parameters examined in this study were considered to be sufficient for the evaluation of the severity of varicose veins. In particular, 4SR% and RT50, which reflect venous reflux in the early venous refilling phase, were the best diagnostic parameters.

The usefulness of FVP measurement utilizing manual calf compression and the significance of the early phase of venous refilling in the varicose veins limbs were confirmed.

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References

Matsuda H. , Ota T. , Okada M. , et al: Direct phlebography for visualization of the deep veins in the lower extremities. Vascular Surgery 26:529-536, 1992.

Browse NL , Burnand KG , Thomas ML : Physiology and functional anatomy: The physiology of the calf pump . In: Diseases of the Veins. London: Edward Arnold, 1988, pp 60-63.

Arnoldi CC : Physiology and pathophysiology of the venous pump of the calf. In: Controversies in the Management of Venous Disorders. London : Butterworths, 1989, pp 6-23.

DeCamp PT , Schramei RJ , Ray CJ , et al: Ambulatory venous pressure determinations in postphlebitic and related syndromes. Surgery 29:44-70, 1951.

Arnoldi CC : Venous pressure in the leg of healthy human subjects at rest and during muscular exercise in the nearly erect position. Acta Chir Scand 130:570-583, 1965.

Arnoldi CC : Venous pressure in patients with valvular incompetence of the veins of the lower limb. Acta Chir Scand 132:628-645, 1966.

Bjordal RI : Pressure and flow measurements in venous insufficiency of the legs . In: Controversies in the Management of Venous Disorders. London: Butterworths, 1989, pp 24-35.

Porter JM , Rutherford RB , Clagett GP , et al: Reporting standards in venous disease. J Vasc Surg 8:172-181, 1988.

Kistner RL : Surgical repair of a venous valve. Straub Clin Proc 34:41-43, 1968.

10.

Szendro G. , Nicolaides AN , Zukowski AJ , et al: Duplex scanning in the assessment of deep venous incompetence . J Vasc Surg 4:237-242, 1986.

11.

Vasdekis SN , Clarke GH , Nicolaides AN : Quantification of venous reflux by means of duplex scanning. J Vasc Surg 10:670-677, 1989.

12.

Welkie JF , Comerota AJ , Katz ML , et al: Hemodynamic deterioration in chronic venous disease. J Vasc Surg 16:733-740,1992.

13.

Gillespie DL , Cordts PR , Hartono C. , et al: The role of air plethysmography in monitoring results of venous surgery. J Vasc Surg 16:674-678, 1992.

14.

Nicolaides AN , Christopoulos DC : Methods of quantitation of chronic venous insufficiency. In: Venous Disorders. Philadelphia : WB Saunders, 1991 , pp 77-90.

15.

Belacaro G. , Labropoulous N. , Christopoulos D. , et al: Noninvasive tests in venous insufficiency . J Cardiovasc Surg 34:3-11, 1993.

16.

Raju S. , Fredericks R. , Lishman P. , et al: Observations on the calf venous pump mechanism: Determinants of postexercise pressure. J Vasc Surg 17:459-469, 1993.

17.

Burnand KG , O'Donnell TF , Thomas ML , et al: The relative importance of incompetent communicating veins in the production of varicose veins and venous ulcers. Surgery 82:9-14, 1977.

18.

Raju S. , Fredericks R. : Hemodynamic basis of stasis ulceration—a hypothesis. J Vasc Surg 13:491-495, 1991.

19.

van Bemmelen PS , Bedford G. , Beach K. , et al: Quantitative segmental evaluation of venous valvular reflux with duplex ultrasound scanning . J Vasc Surg 10:425-431, 1989.

20.

Sarin S. , Shields DA , Scurr JH , et al: Photoplethysmography: A valuable noninvasive tool in the assessment of venous dysfunction. J Vasc Surg 16:154-162, 1992.

21.

Nicolaides AN , Hussein MK , Szendro G. , et al: The relation of venous ulceration with ambulatory venous pressure measurements. J Vasc Surg 17:414-419, 1993.