The value of air plethysmography in predicting clinical outcome after surgical treatment of chronic venous insufficiency.
OBJECTIVE
The role of air plethysmography (APG) as a predictor of clinical outcome after surgery in venous disease is yet to be defined. The purpose of this study was to investigate the value of APG in predicting clinical outcome after venous surgery for chronic venous insufficiency (CVI).


METHODS
Seventy-three extremities in 71 patients with Class 3 through 6 CVI were assessed preoperatively with CEAP (c linical, e tiologic, a natomic, p athophysiologic) criteria, standing reflux duplex ultrasound scan, and APG with measurements of preoperative venous filling index (VFI), venous volumes, ejection fraction, and residual volume fraction. After surgical treatment of the affected limbs, repeat APG studies were obtained within 6 weeks. Established venous reporting standards were used for follow-up to calculate clinical symptom scores (CSSs) in each patient.


RESULTS
Superficial venous reflux occurred alone in 24 limbs or in conjunction with perforator incompetence in 26 limbs. Deep and superficial reflux, with or without perforator incompetence, was found in 16 limbs, and seven limbs had isolated deep insufficiency. Follow-up was available in 60 of 71 patients (mean period, 44.3 months). Postoperative APG demonstrated significant hemodynamic changes after surgery as measured with VFI, venous volumes, ejection fraction, and residual volume fraction. Mean CSSs decreased from 7.35 +/- 0.56 preoperatively to 1.79 +/- 0.32 at late follow-up after surgery (P <.001). With the use of logistic regression, the parameter correlating most closely with clinical outcome was the VFI. A normal postoperative VFI (</= 2 mL/s) predicted a good clinical outcome (CSS </= 2) in follow-up patients, with a positive predictive value of 94%, a specificity of 89%, and a sensitivity of 70%.


CONCLUSIONS
Normalization of the VFI after venous surgery for CVI is predictive of a good clinical outcome. This APG measurement may be a useful parameter to predict adequacy of surgery in patients with venous insufficiency.
Owens
L V
LV
Departments of Surgery, Division of Vascular Surgery and Biostatistics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA.
Farber
M A
MA
Young
M L
ML
Carlin
R E
RE
Criado-Pallares
E
E
Passman
M A
MA
Keagy
B A
BA
Marston
W A
WA
D000328:Adult; D000368:Aged; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010991:Plethysmography / Q000379:methods*; D011184:Postoperative Period; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011336:Probability; D012039:Regional Blood Flow; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods*; D014689:Venous Insufficiency / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery*