Role of Physiologic Testing in Venous Disorders

JEFFREY K. RAINES and JOSE I. ALMEIDA

Of the 25 million Americans with venous insufficiency, approximately 7 million exhibit serious symptoms such as edema, skin changes, and venous ulcers.1 About 1 million seek formal medical advice annually and do so for symptoms of venous insufficiency. Approximately 80% of venous patients are managed conservatively with observation, leg elevation, and support stockings; the remainder are treated surgically with vein stripping or endovenous ablation. Most investigators acknowledge with the development of safe, less traumatic, and effective endovenous techniques for venous insufficiency, more individuals in the population will seek treatment, and physicians will be more inclined to move from conservative therapy to surgical therapy.

Physiologic testing is used to define deep venous thrombosis and identify, grade, and follow venous insufficiency. Since more patients will be presenting for therapy because of improved outcomes with endovenous techniques over traditional surgery, physiologic testing will take on increasing importance. For purposes of this chapter, physiologic testing includes the various devices based on plethysmo-graphic concepts, and color flow duplex imaging. The goal of these studies is to provide accurate information describing the hemodynamic or anatomic characteristics of the patient with chronic venous insufficiency, precluding the need for invasive studies.2

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