title: The edema tester in the evaluation of swollen limbs in venous and lymphatic disease.
abstract: BACKGROUND
  Edema is a common condition in most venous and lymphatic diseases. The ACI edema testers (ET) have been developed to objectively evaluate the presence of edema. Two types of testers have been developed. ET1 is a soft plastic plate (5 x 2 cm) characterised by two parallel protrusions while the ET2 is characterised by two lines of 7 holes.
  
  
  METHODS
  The ETs are applied onto the internal perimalleolar region with the protrusions/holes in contact with the skin. A blood pressure cuff is applied over the area (pressure maintained at 50 mmHg for a period between 1-3 minutes). When the cuff is removed, with the ET1 skin marks are usually just visible in normal limbs (they disappear in a few minutes). We studied 22 normal limbs, 19 with varicose veins, 22 with chronic venous insufficiency, 5 with primary lymphedema and 8 with severe chronic lymphedema.
  
  
  RESULTS
  In limbs with severe edema the whole length of the protrusions is visible; with moderate edema only a part of the protrusions is visible. With the ET2 skin marks are just visible in normal limbs (only the larger holes). Marks disappear in a few minutes in normal limbs while in limbs with edema the number of visible holes is increased (in severe edema all holes are visible). There were significant differences between normals and patients (considering skin mark length, number of visible holes and disappearance times).
  
  
  CONCLUSIONS
  The two testers separated patients with different severity of edema due to chronic venous or lymphatic problems. In severe lymphatic problems all parameters were different (p < 0.02) from those observed in venous disease. A reproducibility study indicated that the ET tests have minimal variations in mark visibility or length or hole numbers (for the ET2).
authors.affiliation: Microcirculation Laboratory, Cardiovascular Institute, Chieti University, PAP/PEA Institute, San Valentino, Pescara.
authors.forename: M R
authors.initials: MR
authors.lastname: Cesarone
authors.forename: G
authors.initials: G
authors.lastname: Belcaro
authors.forename: A N
authors.initials: AN
authors.lastname: Nicolaides
authors.forename: E
authors.initials: E
authors.lastname: Arkans
authors.forename: G
authors.initials: G
authors.lastname: Laurora
authors.forename: M T
authors.initials: MT
authors.lastname: De Sanctis
authors.forename: L
authors.initials: L
authors.lastname: Incandela
mesh_terms: D000328:Adult; D019719:Diagnostic Equipment; D004487:Edema / Q000175:diagnosis*; D005069:Evaluation Studies as Topic; D005121:Extremities / Q000098:blood supply; D006801:Humans; D008206:Lymphatic Diseases / Q000175:diagnosis*; D008875:Middle Aged; D014648:Varicose Veins / Q000175:diagnosis*; D014689:Venous Insufficiency / Q000175:diagnosis*