Ambulatory venous pressure: correlation with skin condition and role in identifying surgically correctible disease.

OBJECTIVES

(1) To evaluate the full spectrum of venous skin damage with respect to ambulatory venous pressure. (2) To determine whether the ambulatory venous pressure/tourniquet test can be used to select patients for superficial venous surgery (eg. long or short saphenous stripping).

DESIGN

Prospective study.

SETTING

Vascular studies unit.

MATERIALS AND

METHODS

Ambulatory venous pressure was measured in a larger sample of limbs (360) with a wide spectrum of venous disease. In addition the effect of a tourniquet placed below the knee on ambulatory venous pressure and venous refilling time was assessed in 234 limbs. This was compared with Duplex assessment of deep and superficial venous reflux at this site.

RESULTS

There was a linear trend towards more severe skin damage with increasing ambulatory venous pressure. Ulceration was associated with more severe calf muscle pump dysfunction (higher ambulatory venous pressure) than were lipodermatosclerosis, eczema or pigmentation. The tourniquet test was not able to distinguish between deep and superficial reflux as determined by Duplex scanning.

CONCLUSIONS

Ambulatory venous pressure should be used to quantify venous insufficiency and remains the reference standard test of the venous calf muscle pump. The tourniquet test should not be used to select patients for surgery since it cannot distinguish deep from superficial venous incompetence. Venous reflux is best localised using Duplex ultrasound.