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

Abstract

Background: The diagnostic evaluation of chronic venous disease (CVD) of the lower limbs (LLs) is mainly based on duplex ultrasound (DUS). Invasive venous pressure measurements (VPMs) are seldom performed in specialized centers with still controversial results. The noninvasive Doppler method has not been accepted as a validate method as the emerging values are influenced by several environmental and biological factors, and do not correspond to hydrostatic pressure. Therefore, these values will be defined as venous pressure index (VPI). In our previous experience, the VPI was accepted by patients in the daily practice, and the VPI was significantly correlated with C of C.E.A.P. (P < 0.05 - 0.0001) and furnished useful hemodynamic information. This study was to verify the role and clinical implications of the VPI measurements in the pathophysiology and diagnostics of superficial CVD of the LL.

Methods: The 2,098 LLs of 1,049 patients affected with CVD and/or other pathologies of the LL were subjected to DUS investigations. The 1,212 LLs of 606 patients were subjected to VPI measurements which were compared with 162 normals. LLs with venous malformations and deep venous disease were excluded owing to the small number of cases. Standing and ambulatory VPIs were detected by Doppler method at the ankle in correspondence of the greater saphenous vein (GSV), smaller saphenous vein (SSV) and posterior tibial vein (PTV). The VPI mean values were correlated with the site, extension and various combinations of reflux (R) and analyzed.

Results: Standing VPI is significantly related with the site, extension and combinations of venous R, while the ambulatory VPI did not furnish significant data. Mean VPI values: GSV > SSV; GSV with isolated R at the leg > GSV at the thigh; additional R in perforators increases VPI in all the superficial districts; superficial R increases VPI in PTV.

Conclusions: Standing VPI is the significant expression of the hemodynamic alteration in the various venous districts. R of GSV at the leg and in perforators is related with higher VPI and severity of the disease. Superficial venous hypertension is correlated with deep venous hypertension. Doppler VPI measurement is a simple repeatable, highly predictive investigation; it furnishes precious hemodynamic information for selection, treatment and follow-up of patients.




J Curr Surg. 2015;5(4):188-198
doi: http://dx.doi.org/10.14740/jcs282e