The value of hemodynamic measurements by air plethysmography in diagnosing venous obstruction of the lower limb.
Air plethysmography (APG) is a functional, noninvasive test that can assess volumetric changes in the lower limb and might therefore be used as a diagnostic tool in chronic deep venous disease. However, use of APG in chronic deep venous obstructive disease remains debatable. This study assessed the clinical value of APG in identifying chronic deep venous obstruction.



All patients referred to our tertiary, outpatient clinic between January 2011 and August 2013 with chronic venous complaints and suspected outflow obstruction underwent an outflow fraction (OF), ejection fraction (EF), and residual volume fraction (RVF) test using APG. Duplex ultrasound and magnetic resonance venography were used to establish whether and where obstruction was present. Diagnostic values of these tests were assessed for obstructions at different levels of the deep venous system.



A total of 312 limbs in 248 patients were tested. Mean age was 45.5 ± 14.0 years, and 62.5% were female. In post-thrombotic disease, specificity and positive predictive value for OF were as high as 98.4% and 95.0%, respectively; however, sensitivity was 34.8% and negative predictive value was 29.6%, with no clinically relevant positive or negative likelihood ratios. No clinically relevant differences were observed in stratifying for level of obstruction. EF and RVF were as inconclusive. Neither could these parameters be used in diagnosing nonthrombotic iliac vein compression.



We found a poor correlation between OF, EF, or RVF, determined by APG, and the presence of chronic deep venous obstruction. Therefore, use of its relative parameters is unwarranted in daily clinical practice.
Department of Vascular Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands; CARIM School for Cardiovascular Diseases, Maastricht, The Netherlands. Electronic address: r.kurstjens@maastrichtuniversity.nl.
Ralph L M
RL
Kurstjens
Department of Vascular Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands; CARIM School for Cardiovascular Diseases, Maastricht, The Netherlands.
Mark A F
MA
de Wolf
Department of Vascular Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands.
Sarah A
SA
Alsadah
Department of Radiology, VieCurie Medical Centre, Venlo, The Netherlands.
Carsten W K P
CW
Arnoldussen
Department of Vascular Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands; CARIM School for Cardiovascular Diseases, Maastricht, The Netherlands.
Rob H W
RH
Strijkers
Department of Vascular Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands; Department of Vascular Surgery, University Hospital Aachen, Aachen, Germany.
Irwin M
IM
Toonder
Department of Vascular Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands; CARIM School for Cardiovascular Diseases, Maastricht, The Netherlands; Department of Vascular Surgery, University Hospital Aachen, Aachen, Germany.
Cees H A
CH
Wittens
D000328:Adult; D005260:Female; D006439:Hemodynamics; D006801:Humans; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D010991:Plethysmography; D018616:Ultrasonography, Doppler, Duplex; D014689:Venous Insufficiency / Q000175:diagnosis*