van Bemmelen P S, Mattos M A, Hodgson K J, Barkmeier L D, Ramsey D E, Faught W E, Sumner D S
Department of Surgery, Southern Illinois University School of Medicine, Springfield 62794-9230.
J Vasc Surg. 1993 Nov;18(5):796-807.
Duplex ultrasonography with distal cuff deflation was used to determine the presence and size of incompetent veins and compare the results with those of air plethysmography in patients with chronic venous insufficiency.
Thirty-two legs underwent a detailed study with both modalities. Sixteen legs had venous ulceration, six had stasis dermatitis, and ten had symptomatic varicose veins without skin changes.
Although the venous filling index (VFI) in limbs with ulcers (5.4 +/- 3.8 ml/sec) and dermatitis (7.7 +/- 4.6 ml/sec) was significantly higher (p < 0.05) than it was in limbs with varicose veins (2.6 +/- 1.7 ml/sec), there was a large amount of overlap. Only 13% of ulcerated legs had VFI greater than 10 ml/sec. Sixty-three percent of legs with ulcers, 33% of legs with dermatitis, and 90% of legs with varicose veins had VFIs less than 5 ml/sec. Mean ejection fractions (EFs) in the three groups were similar, ranging from 45% to 52%. Combining VFI and EF did not lessen the overlap between groups. Forty-one percent of limbs with ulcers or dermatitis had air plethysmography parameters in the normal or intermediate area (VFI < 5 ml/sec; EF > 40%), which in previous studies corresponded to an incidence of ulceration of only 2%. VFI had a significant but weak correlation (r = 0.39) with the diameter of incompetent veins at the knee and a somewhat stronger relationship (r = 0.55) with the diameter of lower leg veins. Total venous volume correlated moderately well with calf vein diameter (r = 0.75). The clinical status of the leg did not correlate with the diameters of incompetent veins at the knee or calf levels. All limbs with an obstructed outflow had EFs less than 60% and ulcers or dermatitis.
We conclude that plethysmographic measurements of functional venous parameters (VFI,EF) do not discriminate well between limbs with uncomplicated varicose veins and limbs with ulcers or stasis dermatitis and that VFI correlates poorly with the presence of incompetent veins and their diameters. Both duplex scanning and plethysmography seem to be necessary for a complete evaluation of limbs with chronic venous insufficiency.
采用远端袖带放气的双功超声检查来确定功能不全静脉的存在及大小，并将结果与慢性静脉功能不全患者的空气体积描记法结果进行比较。
对32条腿进行了两种检查方式的详细研究。16条腿有静脉溃疡，6条有淤积性皮炎，10条有症状性静脉曲张但无皮肤改变。
尽管溃疡肢体（5.4±3.8毫升/秒）和皮炎肢体（7.7±4.6毫升/秒）的静脉充盈指数（VFI）显著高于静脉曲张肢体（2.6±1.7毫升/秒）（p<0.05），但存在大量重叠。只有13%的溃疡腿VFI大于10毫升/秒。63%的溃疡腿、33%的皮炎腿和90%的静脉曲张腿VFI小于5毫升/秒。三组的平均射血分数（EF）相似，范围为45%至52%。结合VFI和EF并没有减少组间的重叠。41%的溃疡或皮炎肢体空气体积描记法参数处于正常或中间范围（VFI<5毫升/秒；EF>40%），在先前研究中这仅对应2%的溃疡发生率。VFI与膝部功能不全静脉直径有显著但较弱的相关性（r = 0.39），与小腿静脉直径的关系稍强（r = 0.55）。总静脉容量与小腿静脉直径中度相关（r = 0.75）。腿部的临床状况与膝部或小腿水平功能不全静脉的直径无关。所有流出道阻塞的肢体EF均小于60%，并有溃疡或皮炎。
我们得出结论，功能性静脉参数（VFI、EF）的体积描记测量在单纯性静脉曲张肢体与有溃疡或淤积性皮炎的肢体之间区分效果不佳，且VFI与功能不全静脉的存在及其直径相关性较差。对于慢性静脉功能不全肢体的全面评估，双功扫描和体积描记法似乎都是必要的。
