Pathophysiologic evaluation of chronic venous stasis with ambulatory venous pressure studies.

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 seconds 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 found to be complementary and added extra-anatomical information. Based on these special studies, a rational approach to the treatment of venous insufficiency has evolved. The early results are encouraging.