title: Photoplethysmographic venous refilling times following ultrasound guided foam sclerotherapy for symptomatic superficial venous reflux: relationship with clinical outcomes.
abstract: BACKGROUND
  Digital photoplethysmography (PPG) provides an inexpensive, reproducible, quantitative, non-invasive assessment of lower limb venous function.
  
  
  OBJECTIVE
  To examine the relationship between venous refilling time (VRT) and severity of venous disease, and also between changes in VRT and symptomatic improvement after ultrasound guided foam sclerotherapy (UGFS) for symptomatic superficial venous reflux (SVR).
  
  
  METHODS
  Prior to and 6 months after UGFS, 246 patients (317 limbs) completed a symptom questionnaire, underwent duplex ultrasonography and clinical assessment, and VRT measurement by digital PPG. Health related quality of life (HRQL) questionnaires were also completed.
  
  
  RESULTS
  Median VRT improved from 11 to 31 s (P < 0.0005, Wilcoxon Signed Ranks). Abnormal VRT (<20 s) correlated well with the presence of SVR on duplex (sensitivity 75%, specificity 94%). Pre-treatment there was a significant relationship between reducing VRT and increasing CEAP clinical grade (P < 0.0005, chi(2)), extent of SVR on duplex (P < 0.0005) and a non-significant relationship with overall increasing symptom severity (P = 0.097). Relief of all symptoms was more likely when there was normalisation of VRT after treatment (80% vs. 65%, P < 0.0005, chi(2)). Pre-treatment VRT correlated with both generic physical (r = 0.428, P = 0.002) and disease-specific (r = -0.413, P = 0.003, Spearman's rank) HRQL.
  
  
  CONCLUSIONS
  UGFS for SVR improves VRT measured by digital PPG and that improvement correlates with symptom relief.
authors.affiliation: Department of Vascular Surgery, Heart of England NHS Trust, Birmingham University, Birmingham, UK. katydarvall@btinternet.com
authors.forename: K A L
authors.initials: KA
authors.lastname: Darvall
authors.forename: R C
authors.initials: RC
authors.lastname: Sam
authors.forename: G R
authors.initials: GR
authors.lastname: Bate
authors.forename: D J
authors.initials: DJ
authors.lastname: Adam
authors.forename: S H
authors.initials: SH
authors.lastname: Silverman
authors.forename: A W
authors.initials: AW
authors.lastname: Bradbury
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D035002:Lower Extremity / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D017156:Photoplethysmography; D012597:Sclerosing Solutions / Q000627:therapeutic use; D015911:Sclerotherapy / Q000379:methods*; D012720:Severity of Illness Index; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D018084:Ultrasonography, Interventional; D014648:Varicose Veins / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000628:therapy*; D014689:Venous Insufficiency / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy; D055815:Young Adult
chemical_list: D012597:Sclerosing Solutions