Owens L V, Farber M A, Young M L, Carlin R E, Criado-Pallares E, Passman M A, Keagy B A, Marston W A
Departments of Surgery, Division of Vascular Surgery and Biostatistics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA.
J Vasc Surg. 2000 Nov;32(5):961-8. doi: 10.1067/mva.2000.110508.
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).
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.
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%.
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.
空气容积描记法（APG）作为静脉疾病手术后临床结局预测指标的作用尚未明确。本研究旨在探讨APG在预测慢性静脉功能不全（CVI）静脉手术后临床结局中的价值。
对71例3至6级CVI患者的73条肢体进行术前评估，采用CEAP（临床、病因、解剖、病理生理）标准、站立位反流双功超声扫描以及APG测量术前静脉充盈指数（VFI）、静脉容积、射血分数和残余容积分数。对患侧肢体进行手术治疗后，在6周内重复进行APG研究。采用既定的静脉报告标准进行随访，计算每位患者的临床症状评分（CSS）。
24条肢体单独出现浅静脉反流，26条肢体合并穿通支功能不全。16条肢体出现深静脉和浅静脉反流，伴或不伴穿通支功能不全，7条肢体存在孤立性深静脉功能不全。71例患者中有60例获得随访（平均随访时间44.3个月）。术后APG显示，术后VFI、静脉容积、射血分数和残余容积分数测量显示出显著的血流动力学变化。平均CSS从术前的7.35±0.56降至术后晚期随访时的1.79±0.32（P<.001）。采用逻辑回归分析，与临床结局相关性最密切的参数是VFI。术后VFI正常（≤2 mL/s）可预测随访患者的良好临床结局（CSS≤2），阳性预测值为94%，特异性为89%，敏感性为70%。
CVI静脉手术后VFI正常可预测良好的临床结局。这种APG测量可能是预测静脉功能不全患者手术是否充分的有用参数。
