Eifell Ron K G, Ashour Hamdy Y, Lees Tim A
Department of Vascular Surgery at Queen Elizabeth Hospital, UK.
J Vasc Surg. 2006 Oct;44(4):794-802. doi: 10.1016/j.jvs.2006.06.007.
Quantitative measurements of chronic venous insufficiency (CVI) are sensitive in detecting the presence of CVI but have low specificity in differentiating clinical severities of CVI as defined by the CEAP classification. One possible reason for this is measurement techniques do not assess variables that reflect hemodynamic changes that occur during normal exercise. Our aim was to compare the association of variables determined from a new technique, continuous ambulatory venous pressure monitoring (CAVPM), and those of conventional AVP measurement with the clinical severity of chronic venous insufficiency in patients with primary venous reflux.
Fifty-four limbs of 49 patients with CVI and 15 healthy controls were studied. CVI clinical severity was classified according to CEAP as C2&C3 (mild disease), C4 (moderate disease), and C5&C6 (severe disease). All participants underwent duplex ultrasound scanning to rule out the presence of reflux in the control group and to confirm it in the patient groups. Conventional AVP measurements, including 90% refilling time (RT90), were compared with the new CAVP variables of mean walking pressure (MWP) and percentage fall in walking pressure (%FWP). Data were analyzed by analysis of variance using the Kruskal-Wallis test, and comparisons between groups were performed using Mann-Whitney tests. Discriminant analysis was used to determine the ability of a test to classify limbs into clinical classes.
Conventional AVP measurements could not differentiate between the control group and the presence of mild disease (P = .56) but did differentiate between controls and severe disease as well as mild and severe disease (P < .001). RT90 detected differences between controls and reflux groups (P < .001) but not between moderate (C4) and severe (C5&C6) clinical groups (P > .5). MWP and %FWP showed significant differences between all clinical severities and controls (P < .001).
In the assessment of CVI, mean walking pressure and percent fall in walking pressure are more reliably associated with anatomic distribution of reflux and clinical severity of CVI than the gold standard investigations of conventional AVP and RT90.
慢性静脉功能不全（CVI）的定量测量在检测CVI的存在方面很敏感，但在区分CEAP分类所定义的CVI临床严重程度方面特异性较低。造成这种情况的一个可能原因是测量技术没有评估反映正常运动期间发生的血流动力学变化的变量。我们的目的是比较通过一种新技术——连续动态静脉压监测（CAVPM）确定的变量以及传统平均静脉压（AVP）测量的变量与原发性静脉反流患者慢性静脉功能不全临床严重程度之间的关联。
对49例CVI患者的54条肢体和15名健康对照者进行研究。根据CEAP将CVI临床严重程度分为C2&C3（轻度疾病）、C4（中度疾病）和C5&C6（重度疾病）。所有参与者均接受双功超声扫描，以排除对照组中的反流情况，并在患者组中确认反流情况。将传统AVP测量值，包括90%再充盈时间（RT90），与新的CAVP变量平均步行压力（MWP）和步行压力下降百分比（%FWP）进行比较。使用Kruskal-Wallis检验通过方差分析对数据进行分析，并使用Mann-Whitney检验进行组间比较。判别分析用于确定一项测试将肢体分类到临床类别的能力。
传统AVP测量无法区分对照组和轻度疾病组（P = 0.56），但能区分对照组与重度疾病组以及轻度与重度疾病组（P < 0.001）。RT90检测到对照组与反流组之间存在差异（P < 0.001），但中度（C4）和重度（C5&C6）临床组之间无差异（P > 0.5）。MWP和%FWP在所有临床严重程度与对照组之间均显示出显著差异（P < 0.001）。
在CVI评估中，与传统AVP和RT90的金标准检查相比，平均步行压力和步行压力下降百分比与反流的解剖分布和CVI的临床严重程度更可靠地相关。
