Evaluation of methods for detecting venous reflux. Perspectives in venous insufficiency
S. Raju and R. Fredericks
Department of Surgery, University of Mississippi Medical Center, Jackson 39216-4505.
Using 793 limbs with nonobstructive venous reflux, we evaluated a number of
techniques used for the assessment of venous reflux. The venous Doppler
examination was found to be a reliable screening tool with excellent
sensitivity and good specificity. Photoplethysmography was 97% sensitive in
patients with ambulatory venous hypertension; however, in milder forms of
reflux, it was less sensitive. The major drawback of photoplethysmography
was the large number of false-positive results obtained. Ambulatory venous
pressure measurement and another pressure-based technique, Valsalva-induced
foot venous pressure measurement, defined overlapping but different normal
and abnormal limbs. Descending venography, when performed as described by
Kistner et al, was found to be a reliable tool to assess reflux with more
than a 90% sensitivity. The horizontal technique of performing descending
venography and nucleotide descending venographies had unacceptably low
sensitivity and were abandoned. Features of venous reflux as outlined by
these modern technical tools are described.
