title: Comparison of manual compression release with distal pneumatic cuff maneuver in the ultrasonic evaluation of superficial venous insufficiency.
abstract: BACKGROUND
  Venous reflux can be elicited either manually or by pneumatic tourniquet, and previous studies did not indicate any significant difference between these manoeuvres in patients with superficial venous insufficiency (SVI).
  
  
  OBJECTIVE
  To investigate if two methods correlate in patients with CVI.
  
  
  METHODS
  Venous reflux was studied in 94 venous segments of 57 limbs in 52 consecutive patients with SVI. Limbs were divided into two groups: group I (CEAP C2-C3) and group II (CEAP C4-C6). A colour duplex scanner was used to determine quantitative venous reflux at the sapheno-femoral junction (SFJ), at the sapheno-popliteal junction (SPJ), and in the greater saphenous vein in the thigh (GSV). Patients received both manual compression and cuff deflation method in eliciting venous reflux. The parameters assessed were the duration of reflux (second) and the peak reflux velocity (cm/s).
  
  
  METHODS
  Paired t-test was used to evaluate differences between the two methods. Statistical significance was recorded when the p-value was <0.05. Bland and Altman plot was also used to assess the agreement of the same measurement.
  
  
  RESULTS
  There were 58 venous segments in group I and 36 in group II. In group I, there were no significant differences in the duration of reflux at the SFJ, SPJ, and in the GSV. On the contrary, peak reflux velocity was found to be significantly higher at the SFJ and in the GSV (p=0.022 and 0.006, respectively). In group II, there was no significant difference in the duration of reflux at the SFJ and SPJ between the two methods. On the contrary, manual compression maneuver produced significantly higher peak reflux velocity than at the SFJ and in the GSV (p=0.023 and 0.002, respectively). Bland and Altman plot analysis, manual compression method displayed a relatively good agreement with cuff deflation manoeuvre both in group I and group II. In contrast, concerning the peak reflux velocity, relative wide limits of agreement were found between the two methods.
  
  
  CONCLUSIONS
  Unlike previously published reports, our results lead to apparent discrepancies in the quantitative evaluation of venous reflux using different methodology.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, Tokyo, 162-8666 Japan. yamakai@prs.twmu.ac.jp
authors.forename: T
authors.initials: T
authors.lastname: Yamaki
authors.forename: M
authors.initials: M
authors.lastname: Nozaki
authors.forename: H
authors.initials: H
authors.lastname: Sakurai
authors.forename: M
authors.initials: M
authors.lastname: Takeuchi
authors.forename: K
authors.initials: K
authors.lastname: Soejima
authors.forename: T
authors.initials: T
authors.lastname: Kono
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001783:Blood Flow Velocity; D006801:Humans; D007866:Leg / Q000098:blood supply*; D008875:Middle Aged; D011312:Pressure; D014111:Tourniquets; D018615:Ultrasonography, Doppler, Color / Q000379:methods*; D014689:Venous Insufficiency / Q000000981:diagnostic imaging* / Q000503:physiopathology