Comparison of Four Haemodynamic Tests that Quantify Superficial Venous Insufficiency

Christopher R Lattimer; Philipp B Rudolphi; Annalena Recke; George Geroulakos; Evi Kalodiki; Birgit K Kahle

doi:10.1016/j.ejvs.2018.10.003

Comparison of Four Haemodynamic Tests that Quantify Superficial Venous Insufficiency

Eur J Vasc Endovasc Surg. 2019 Apr;57(4):570-577. doi: 10.1016/j.ejvs.2018.10.003. Epub 2019 Mar 19.

Authors

Christopher R Lattimer¹, Philipp B Rudolphi², Annalena Recke², George Geroulakos³, Evi Kalodiki⁴, Birgit K Kahle²

Affiliations

¹ Josef Pflug Vascular Laboratory, Ealing Hospital, Middlesex, UK; Department of Surgery and Cancer, Imperial College, London, UK; West London Vascular and Interventional Centre, London North West University Healthcare, UK. Electronic address: c.lattimer09@imperial.ac.uk.
² Klinik für Dermatologie, Allergologie und Venerologie, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany.
³ Josef Pflug Vascular Laboratory, Ealing Hospital, Middlesex, UK; Department of Surgery and Cancer, Imperial College, London, UK.
⁴ Josef Pflug Vascular Laboratory, Ealing Hospital, Middlesex, UK; Department of Surgery and Cancer, Imperial College, London, UK; West London Vascular and Interventional Centre, London North West University Healthcare, UK.

PMID: 30898493
DOI: 10.1016/j.ejvs.2018.10.003

Abstract

Objectives: Reflux assessment with ultrasound (U/S) is usually qualitative. Quantitative measurements of superficial venous insufficiency (SVI) include the venous arterial flow index (VAFI), recirculation index (RCI), venous filling index (VFI), and the postural diameter change (PDC) of the saphenous trunk. The aim was to investigate their relationship.

Materials and methods: This was an observational study performed on patients with varicose veins and hospital employees. Four haemodynamic parameters were measured in 21 legs from 16 subjects. Legs were divided into no reflux (n = 7) and reflux (n = 14). The VAFI is the U/S ratio of common femoral vein volume flow divided by the common femoral artery volume flow, performed supine. The RCI is the U/S ratio of reflux volume over antegrade volume within the saphenous trunk after calf compression, standing. The VFI is the rate of calf volume increase on dependency measured in mL/s, using air plethysmography. The PDC is the percentage reduction of the saphenous trunk diameter from standing to lying, using U/S.

Results: The clinical part of the CEAP classification was: C₀ = 3, C₁ = 4, C₂ = 5, C₃ = 1, C_4a = 1, C_4b = 6, C₅ = 1. All four tests demonstrated significant differences between the two groups with minimal overlap (Mann Whitney U test): VAFI (p = .028), RCI (p < .0005), VFI (p = .001), and PDC (p = .014). Furthermore, significant correlations were observed with the tests: VAFI vs. RCI (r = .532, p = .015), VFI (r = .489, p = .025) and PDC (r = -.474, p = .030); RCI vs. VFI (r = .446, p = .043) and PDC (r = -.527, p = .014).

Conclusions: Superficial venous drainage insufficiency should not be confined to an U/S assessment of the presence of reflux, which is qualitative. Quantitative data may be provided using the VAFI, RCI, VFI, and PDC. Understanding why there are significant correlations among these parameters and the preferred objective reference test requires further work.

Keywords: Postural diameter change; Psathakis index; Recirculation index; Superficial venous insufficiency; Venous arterial flow index; Venous filling index.

Publication types

Comparative Study
Observational Study

MeSH terms

Adult
Aged
Case-Control Studies
Female
Hemodynamics*
Humans
Male
Middle Aged
Plethysmography*
Predictive Value of Tests
Reproducibility of Results
Saphenous Vein / diagnostic imaging*
Saphenous Vein / physiopathology
Severity of Illness Index
Ultrasonography / methods*
Varicose Veins / diagnostic imaging*
Varicose Veins / physiopathology
Venous Insufficiency / diagnostic imaging*
Venous Insufficiency / physiopathology