J Curr Surg

Journal of Current Surgery, ISSN 1927-1298 print, 1927-1301 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Curr Surg and Elmer Press Inc

Journal website http://www.currentsurgery.org

Original Article

Volume 5, Number 4, December 2015, pages 188-198

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

Figure 1. VPI Doppler measurement on a right LL of a patient affected with CVI. Placement of the pneumatic cuff and of the flat probe of 8 MHz by plaster is visible.

Figure 2. VPI values of the GSV measured in standing position. C: competent; IAK: incompetent above knee; IBK: incompetent below knee; TI: totally incompetent; TI-IPV: totally incompetent and incompetent perforating veins; TI-CPV: totally incompetent and competent perforating veins.

Figure 3. VPI values of the PTV measured in standing position. C: competent; IAK: incompetent above knee; IBK: incompetent below knee; TI: totally incompetent; TI-IPV: totally incompetent and incompetent perforating veins; TI-CPV: totally incompetent and competent perforating veins.

Figure 4. VPI values of the SSV measured in standing position. C: Competent, I: incompetent; I-IPV: incompetent with incompetent perforating veins.

Figure 5. Ambulatory VPI values of the GSV measured after ten exercises in standing position. C: Competent; IAK: incompetent above knee; IBK: incompetent below knee; TI: totally incompetent; TI-IPV: totally incompetent and incompetent perforating veins; TI-CPV: totally incompetent and competent perforating veins.

Figure 6. The presence of R into the PV appears to be related with a decreased differential VPI measured in the PTV. The exclusion of patients free from IPV the differential VPI remains higher and the difference observed is not significantly different in comparison with the control group.

Figure 7. VPI distribution in the GSV of the limbs with incompetent and competent GSV. The statistic Bayesian test was performed in 1,044 limbs. Sensibility, specificity, the positive predictive value and the negative predictive value were calculated taking into consideration the VPI value of 80 mm Hg as resulting by the Bayesian calculation. The higher VPI peak of frequency corresponds to 60 mm Hg in the limbs with competent GSV, while in the limbs with incompetent GSV a peak comprised between 90 and 100 mm Hg was calculated.

Figure 8. VPI distribution in the SSV of limbs with incompetent and competent SSV. The statistic Bayesian test was performed in 1,044 limbs. Sensibility, specificity, the positive predictive value and the negative predictive value were calculated taking into consideration the VPI value of 70 mm Hg as resulting by the Bayesian calculation. In only three limbs R free and competent SSV the VPI > 70 mm Hg.

Figure 9. VPI distribution in the PTV of limbs with incompetent and competent GSV. The statistic Bayesian test was performed in 1,044 limbs. Sensibility, specificity, the positive predictive value and the negative predictive value were calculated taking into consideration the VPI value of 80 mm Hg as resulting by the Bayesian calculation. Two peaks of VPI are visible. The first one corresponding to a maximum of 60 mm Hg in limbs with competent GSV and the second corresponding to a maximum of 80 mm Hg in limbs with incompetent GSV.

**Table 1.** Distribution of the Patients Subjected to VPI Doppler Measurements
	N	%
CVI: chronic venous insufficiency.
Patients examined	1,049	100
Patients without CVI	162	15.4
Patients with CVI	887	84.5
Average age	52.4 ± 16.2
Male	273	26.0
Female	776	74.0
Right	554	52.8
Left	495	47.1

Table 1. Distribution of the Patients Subjected to VPI Doppler Measurements

CVI: chronic venous insufficiency.

Patients examined

1,049

100

Patients without CVI

162

15.4

Patients with CVI

887

84.5

Average age

52.4 ± 16.2

Male

273

26.0

Female

776

74.0

Right

554

52.8

Left

495

47.1

**Table 2.** Statistical Analysis of the Standing PVI Values of the GSV Measured in Standing Position
	Student’s t-test of the GSV of standing PVI values
C: competent; IAK: incompetent above knee; IBK: incompetent below knee; TI: totally incompetent; TI-IPV: totally incompetent and incompetent perforating veins; TI-CPV: totally incompetent and competent perforating veins.
GSV IAK	N.S.
GSV IBK	0.0002	0.0327
GSV TI	0.00001	0.00001	N.S.
GSV TI-IPV	0.0216	N.S.	N.S.	0.0048
GSV TI-CPV	0.00001	0.00001	0.0344	0.0202	0.00001

Table 2. Statistical Analysis of the Standing PVI Values of the GSV Measured in Standing Position

Student’s t-test of the GSV of standing PVI values

GSV C

GSV IAK

GSV IBK

GSV TI

GSV TI-IPV

C: competent; IAK: incompetent above knee; IBK: incompetent below knee; TI: totally incompetent; TI-IPV: totally incompetent and incompetent perforating veins; TI-CPV: totally incompetent and competent perforating veins.

GSV IAK

N.S.

GSV IBK

0.0002

0.0327

GSV TI

0.00001

N.S.

GSV TI-IPV

0.0216

N.S.

0.0048

GSV TI-CPV

0.00001

0.0344

0.0202

0.00001

**Table 3.** Statistical Analysis of the Standing PVI Values of the PTV in Relation With the Extension of the GSV Valvular Incompetence Measured in Standing Position
	Student’s t-test of the PSV of PVI standing values
C: competent; IAK: incompetent above knee; IBK: incompetent below knee; TI: totally incompetent; TI-IPV: totally incompetent and incompetent perforating veins; TI-CPV: totally incompetent and competent perforating veins.
GSV IAK	0.844
GSV IBK	0.367	0.356
GSV TI	0.001	0.010	0.381
GSV TI-IPV	0.897	0.976	0.406	0.030
GSV TI-CPV	0.0001	0.00001	0.034	0.035	0.00001

Table 3. Statistical Analysis of the Standing PVI Values of the PTV in Relation With the Extension of the GSV Valvular Incompetence Measured in Standing Position

Student’s t-test of the PSV of PVI standing values

GSV C

GSV IAK

GSV IBK

GSV TI

GSV TI-IPV

GSV IAK

0.844

GSV IBK

0.367

0.356

GSV TI

0.001

0.010

0.381

GSV TI-IPV

0.897

0.976

0.406

0.030

GSV TI-CPV

0.0001

0.00001

0.034

0.035

0.00001

**Table 4.** Statistical Analysis of the Standing PVI Values of the SSV Measured in Standing Position by Student’s t-Test
	SSV
The zeros preceding the reported values are 24 in the first column and 43 in the second (t < 0.01). SSV: smaller saphenous vein; C: competent; I: incompetent; IPV: incompetent perforating veins.
SSV C	2.09 E - 24	5.27 E - 43

Table 4. Statistical Analysis of the Standing PVI Values of the SSV Measured in Standing Position by Student’s t-Test

SSV

C SSV

I SSV IPV

The zeros preceding the reported values are 24 in the first column and 43 in the second (t < 0.01). SSV: smaller saphenous vein; C: competent; I: incompetent; IPV: incompetent perforating veins.

SSV C

2.09 E - 24

5.27 E - 43

**Table 5.** Statistical Analysis of the Ambulatory PVI Values of the GSV Measured After Ten Exercises Standing Position Analyzed by Student’s t-Test
GSV	Student’s t-test values
C: competent; IAK: incompetent above knee; IBK: incompetent below the knee; TI: totally incompetent; TI-IPV: totally incompetent and incompetent perforating veins; TI-CPV: totally incompetent and competent perforating veins.
C	0.31	0.36	0.31	0.35	0.30
IAK		0.26	0.94	0.42	0.66
IBK			0.23	0.81	0.11
TI				0.42	0.56
IPV					0.23

Table 5. Statistical Analysis of the Ambulatory PVI Values of the GSV Measured After Ten Exercises Standing Position Analyzed by Student’s t-Test

GSV

Student’s t-test values

IAK

IBK

IPV

CPV

C: competent; IAK: incompetent above knee; IBK: incompetent below the knee; TI: totally incompetent; TI-IPV: totally incompetent and incompetent perforating veins; TI-CPV: totally incompetent and competent perforating veins.

0.31

0.36

0.31

0.35

0.30

IAK

0.26

0.94

0.42

0.66

IBK

0.23

0.81

0.11

0.42

0.56

IPV

0.23

**Table 6.** Statistical Analysis of the Ambulatory PVI Values of the PTV Measured After Ten Exercises Standing Position Analyzed by Student’s t-Test
GSV	Student’s t-test values
C: competent; IAK: incompetent above knee; IBK: incompetent below the knee; TI: totally incompetent; TI-IPV: totally incompetent and incompetent perforating veins; TI-CPV: totally incompetent and competent perforating veins.
GSV C	0.15	0.79	0.00097	0.00069	0.15
GSV IAK		0.52	0.25	0.12	0.85
GSV IBK			0.13	0.07	0.45
GSV TI				0.57	0.43
GSV IPV					0.24

Table 6. Statistical Analysis of the Ambulatory PVI Values of the PTV Measured After Ten Exercises Standing Position Analyzed by Student’s t-Test

GSV

Student’s t-test values

GSV RAK

GSV RBK

GSV RC

GSV RPV

GSV RC WRPV

GSV C

0.15

0.79

0.00097

0.00069

0.15

GSV IAK

0.52

0.25

0.12

0.85

GSV IBK

0.13

0.07

0.45

GSV TI

0.57

0.43

GSV IPV

0.24

**Table 7.** Statistical Analysis by Bayesian Test of VPI Measured in Competent and Incompetent GSV
Bayesian test VPI
The Statistic Bayesian test was performed in 1,044 limbs. Sensibility, specificity, the positive predictive value and the negative predictive value were calculated taking into consideration the VPI value of 80 mm Hg as resulting by the Bayesian calculator (Fig. 7). C 0-1, C 2-6 of C.E.A.P. classification.
VPI		C 0-1		C 2-6
≤ 80	a	56	b	442
> 80	c	8	d	538

CGSV VPI < 80 mm Hg	56	a
IGSV VPI > 80	442	b
CGSV VPI < 80	538	d
CGSV VPI > 80	8	c
Total	1,044	a + b + c + d
Sensibility	0.8750 a/(a + c)
Specificity	0.5490 d/(b + d)
Pos. predictive value	0.1124 a/(a + b)
Neg. predictive value	0.9853 d/(c + d)

Table 7. Statistical Analysis by Bayesian Test of VPI Measured in Competent and Incompetent GSV

Bayesian test VPI

The Statistic Bayesian test was performed in 1,044 limbs. Sensibility, specificity, the positive predictive value and the negative predictive value were calculated taking into consideration the VPI value of 80 mm Hg as resulting by the Bayesian calculator (Fig. 7). C 0-1, C 2-6 of C.E.A.P. classification.

VPI

C 0-1

C 2-6

≤ 80

442

> 80

538

CGSV VPI < 80 mm Hg

IGSV VPI > 80

442

CGSV VPI < 80

538

CGSV VPI > 80

Total

1,044

a + b + c + d

Sensibility

0.8750 a/(a + c)

Specificity

0.5490 d/(b + d)

Pos. predictive value

0.1124 a/(a + b)

Neg. predictive value

0.9853 d/(c + d)

**Table 8.** Statistical Analysis by Bayesian Test of VPI Measured in Competent and Incompetent SSV
Bayesian test SSV
The statistic Bayesian test was performed in 1,044 limbs. Sensibility, specificity, the positive predictive value and the negative predictive value were calculated taking into consideration the VPI value of 70 mm Hg as resulting by the Bayesian calculator (Fig. 8). C 0-1, C 2-6 of C.E.A.P. classification.
VPI		C 0-1		C 2-6
< 70	a	48	b	309
≥ 70	c	3	d	437

CSSV VPI < 70 mm Hg	48	a
ISSV VPI > 70	309	b
CSSV VPI < 70	437	d
CSSV VPI > 70	3	c
Total	797	a + b + c + d
Sensibility	0.9412 a/(a + c)
Specificity	0.5858 d/(b + d)
Pos. predictive value	0.1345 a/(a + b)
Neg. predictive value	0.9932 d/(c + d)

Table 8. Statistical Analysis by Bayesian Test of VPI Measured in Competent and Incompetent SSV

Bayesian test SSV

The statistic Bayesian test was performed in 1,044 limbs. Sensibility, specificity, the positive predictive value and the negative predictive value were calculated taking into consideration the VPI value of 70 mm Hg as resulting by the Bayesian calculator (Fig. 8). C 0-1, C 2-6 of C.E.A.P. classification.

VPI

C 0-1

C 2-6

< 70

309

≥ 70

437

CSSV VPI < 70 mm Hg

ISSV VPI > 70

309

CSSV VPI < 70

437

CSSV VPI > 70

Total

797

a + b + c + d

Sensibility

0.9412 a/(a + c)

Specificity

0.5858 d/(b + d)

Pos. predictive value

0.1345 a/(a + b)

Neg. predictive value

0.9932 d/(c + d)

**Table 9.** Statistical Analysis by Bayesian Test of VPI Measured in PTV of Limbs With Competent and Incompetent GSV
Bayesian test PTV
The statistic Bayesian test was performed in 1,044 limbs. Sensibility, specificity, the positive predictive value and the negative predictive value were calculated taking into consideration the VPI value of 80 mm Hg as resulting by the Bayesian calculator (Fig. 9). C 0-1, C 2-6 of C.E.A.P. classification.
VPI		C 0-1		C 2-6
< 80	a	53	b	484
≥ 80	c	10	d	483

CSSV VPI < 80 mm Hg	53	a
ISSV VPI > 80	484	b
CSSV VPI < 80	483	d
CSSV VPI > 80	10	c
Total	1,030	a + b + c + d
Sensibility	0.8413 a/(a + c)
Specificity	0.4995 d/(b + d)
Pos. predictive value	0.0987 a/(a + b)
Neg. predictive value	0.9797 d/(c + d)

Table 9. Statistical Analysis by Bayesian Test of VPI Measured in PTV of Limbs With Competent and Incompetent GSV

Bayesian test PTV

The statistic Bayesian test was performed in 1,044 limbs. Sensibility, specificity, the positive predictive value and the negative predictive value were calculated taking into consideration the VPI value of 80 mm Hg as resulting by the Bayesian calculator (Fig. 9). C 0-1, C 2-6 of C.E.A.P. classification.

VPI

C 0-1

C 2-6

< 80

484

≥ 80

483

CSSV VPI < 80 mm Hg

ISSV VPI > 80

484

CSSV VPI < 80

483

CSSV VPI > 80

Total

1,030

a + b + c + d

Sensibility

0.8413 a/(a + c)

Specificity

0.4995 d/(b + d)

Pos. predictive value

0.0987 a/(a + b)

Neg. predictive value

0.9797 d/(c + d)