Lattimer C R, Mendoza E
Josef Pflug Vascular Laboratory, Ealing Hospital, Middlesex, UK; Department of Surgery and Cancer, Imperial College, London, UK; West London Vascular & Interventional Centre, Northwick Park Hospital, Harrow, UK.
Venenpraxis-Wunstorf, Wunstorf, Germany.
Eur J Vasc Endovasc Surg. 2016 Dec;52(6):854-861. doi: 10.1016/j.ejvs.2016.09.012. Epub 2016 Oct 24.
Without gravity opposing drainage, most venous diseases would not exist. Therefore, manoeuvres that assess venous function should include gravity. The aim was to "dose" gravity in subjects using static positions and dynamic angulations on a tilt-table and to assess its effects with air plethysmography (APG) and duplex ultrasound over the femoral vein.
Three groups (providing n = 11 legs each) were compared. (a) A control group, without clinical or duplex evidence of venous disease. (b) An obstruction group, with past iliofemoral deep vein thrombosis. (3) A reflux group, with primary varicose veins. A manually operated tilt-table ranging from -70° to 40° in the Trendelenburg position provided rapid tilting (<3 s). The changes in calf volume at -70° (almost standing), -45° (reclining), and 40° (legs-up) were recorded with APG, as well as the rate and duration of the changes. The minor diameter of the femoral vein was recorded at the three tilt positions.
The results were expressed as median (interquartile range). The total working venous volume (mL) in the reflux group was significantly increased: 202 (180-240) mL versus the controls at 138 (119-198) mL, p = .008, and versus the legs with obstruction at 117 (80-154) mL, p < .0005. The venous drainage index (VDI) in mL/second in the obstructed group was significantly reduced: 7 (6-9.6) mL/second, versus the controls at 17.4 (13.9-27.2) mL/second, p < .0005, and versus the legs with varicose veins at 28.1 (25.4-34.4) mL/second, p < .0005. The venous filling index (VFI) in mL/second in the reflux group was significantly increased: 8.1 (4.2-10) mL/second versus the controls at 1.8 (1-2.1) mL/second, p < .0005. The VDI cut-off point discriminating obstruction was ≤10.8 mL/second and the VFI discriminating reflux was ≥ 2.9 mL/second. The femoral vein diameter was reduced significantly with increasing leg elevation.
Manoeuvres using APG on a tilt-table have the potential to quantify the contributions of global obstruction and reflux (mL/second) in patients with venous disease.
若没有重力阻碍静脉回流，多数静脉疾病将不会存在。因此，评估静脉功能的操作应纳入重力因素。本研究旨在通过在倾斜台上采用静态姿势和动态角度对受试者施加不同程度的重力，并运用空气容积描记法（APG）和股静脉双功超声评估其效果。
比较三组受试者（每组11条腿）。（a）对照组，无静脉疾病的临床或双功超声证据。（b）阻塞组，既往有髂股深静脉血栓形成。（c）反流组，患有原发性静脉曲张。一台手动操作的倾斜台可在头低脚高位从 -70°至40°快速倾斜（<3秒）。使用APG记录在 -70°（近乎站立）、-45°（仰卧）和40°（腿部抬高）时小腿容积的变化，以及变化的速率和持续时间。记录三个倾斜位置时股静脉的最小直径。
结果以中位数（四分位间距）表示。反流组的总有效静脉容积（mL）显著增加：202（180 - 240）mL，对照组为138（119 - 198）mL，p = 0.008；与阻塞组的117（80 - 154）mL相比，p < 0.0005。阻塞组的静脉引流指数（VDI，mL/秒）显著降低：7（6 - 9.6）mL/秒，对照组为17.4（13.9 - 27.2）mL/秒，p < 0.0005；与静脉曲张组的28.1（25.4 - 34.4）mL/秒相比，p < 0.0005。反流组的静脉充盈指数（VFI，mL/秒）显著增加：8.1（4.2 - 10）mL/秒，对照组为1.8（1 - 2.1）mL/秒，p < 0.0005。鉴别阻塞的VDI临界值为≤10.8 mL/秒，鉴别反流的VFI临界值为≥2.9 mL/秒。随着腿部抬高，股静脉直径显著减小。
在倾斜台上使用APG的操作有潜力量化静脉疾病患者整体阻塞和反流（mL/秒）的程度。
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