Pathophysiologic Evaluation of Chronic Venous Stasis with Ambulatory Venous Pressure Studies

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Abstract
Seven normal controls and 51 lower extremities with venous insufficiency in 45 patients were studied with ambulatory venous pressure. Measurements were done at rest and during 15 s of exercise without a tourniquet and with 1 or 2 tourniquets at different levels of the extremity. The decrease in pressure during exercise and the time to return to standing levels were used to calculate a venous sufficiency index. Six pathologic categories were identified in patients with chronic venous stasis. Incompetence of perforators was present in 17 cases. A combination of long saphenous vein and perforator incompetence was detected in 10 cases. Thirteen cases had a pattern of regurgitant deep vein incompetence. Two cases had incompetence of the saphenous system. A deep vein obstruction pattern was present in 3 other patients. Ascending and retrograde phlebography was done in 30 of these cases. There was an 83.3% correlation between the venous pressure and phlebographic tests. Contrast studies were complementary and added extra-anatomical information. Based on these special studies, a rational approach to the treatment of venous insufficiency evolved. The early results are encouraging.