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Advanced chronic venous insufficiency is associated with increased calf muscle deoxygenation.
Eur J Vasc Endovasc Surg. 2010 Jun; 39(6):787-94.EJ

Abstract

OBJECTIVE

To determine the temporal relationship between changes in calf muscle deoxygenated haemoglobin (HHb) measured by near-infrared spectroscopy (NIRS) during light-intensity exercise and clinical stages of chronic venous insufficiency (CVI).

DESIGN AND METHODS

Calf muscle HHb level was obtained in 168 limbs of 158 patients with various clinical stages of CVI. Clinical manifestations were categorised according to the CEAP classification (CEAP, clinical, etiological, anatomical and pathophysiological), and the patients were divided into two groups: early CVI (C(0-3),E(p)(,s),A(s)(,d,p),P(r)(,o)) and advanced CVI (C(4-6),E(p)(,s), A(s)(,d,p),P(r)(,o)). Calf venous blood-filling index (FI-HHb) was calculated on standing, then the calf venous ejection index (EI-HHb) was obtained after one tiptoe movement and the venous retention index (RI-HHb) after 10 tiptoe movements.

RESULTS

A total of 116 limbs had early, and 52 had advanced CVI. FI and RI were significantly increased in patients with advanced CVI compared with those with early CVI (P = 0.003, 0.0001, respectively). Similarly, RI was significantly greater in patients who had superficial, combined with deep and/or perforator, insufficiency than in patients with superficial insufficiency alone (P = 0.002). RI showed the strongest correlation with duplex-derived peak reflux velocity in the popliteal vein (r = 0.78, P < 0.0001). Combination of an optimal cut-off point of 0.2 for FI and 2.9 for RI improved the ability to discriminate early from advanced CVI, with a sensitivity of 94% and a specificity of 86%.

CONCLUSIONS

These results suggest that FI and RI, as measured by NIRS, may be promising parameters for discriminating early CVI from advanced CVI.

Authors+Show Affiliations

Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan. Yamakit@aol.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

20227896

Citation

Yamaki, T, et al. "Advanced Chronic Venous Insufficiency Is Associated With Increased Calf Muscle Deoxygenation." European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery, vol. 39, no. 6, 2010, pp. 787-94.
Yamaki T, Nozaki M, Sakurai H, et al. Advanced chronic venous insufficiency is associated with increased calf muscle deoxygenation. Eur J Vasc Endovasc Surg. 2010;39(6):787-94.
Yamaki, T., Nozaki, M., Sakurai, H., Soejima, K., Kono, T., & Hamahata, A. (2010). Advanced chronic venous insufficiency is associated with increased calf muscle deoxygenation. European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery, 39(6), 787-94. https://doi.org/10.1016/j.ejvs.2010.01.031
Yamaki T, et al. Advanced Chronic Venous Insufficiency Is Associated With Increased Calf Muscle Deoxygenation. Eur J Vasc Endovasc Surg. 2010;39(6):787-94. PubMed PMID: 20227896.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Advanced chronic venous insufficiency is associated with increased calf muscle deoxygenation. AU - Yamaki,T, AU - Nozaki,M, AU - Sakurai,H, AU - Soejima,K, AU - Kono,T, AU - Hamahata,A, Y1 - 2010/03/15/ PY - 2009/09/18/received PY - 2010/01/31/accepted PY - 2010/3/16/entrez PY - 2010/3/17/pubmed PY - 2010/8/18/medline SP - 787 EP - 94 JF - European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery JO - Eur J Vasc Endovasc Surg VL - 39 IS - 6 N2 - OBJECTIVE: To determine the temporal relationship between changes in calf muscle deoxygenated haemoglobin (HHb) measured by near-infrared spectroscopy (NIRS) during light-intensity exercise and clinical stages of chronic venous insufficiency (CVI). DESIGN AND METHODS: Calf muscle HHb level was obtained in 168 limbs of 158 patients with various clinical stages of CVI. Clinical manifestations were categorised according to the CEAP classification (CEAP, clinical, etiological, anatomical and pathophysiological), and the patients were divided into two groups: early CVI (C(0-3),E(p)(,s),A(s)(,d,p),P(r)(,o)) and advanced CVI (C(4-6),E(p)(,s), A(s)(,d,p),P(r)(,o)). Calf venous blood-filling index (FI-HHb) was calculated on standing, then the calf venous ejection index (EI-HHb) was obtained after one tiptoe movement and the venous retention index (RI-HHb) after 10 tiptoe movements. RESULTS: A total of 116 limbs had early, and 52 had advanced CVI. FI and RI were significantly increased in patients with advanced CVI compared with those with early CVI (P = 0.003, 0.0001, respectively). Similarly, RI was significantly greater in patients who had superficial, combined with deep and/or perforator, insufficiency than in patients with superficial insufficiency alone (P = 0.002). RI showed the strongest correlation with duplex-derived peak reflux velocity in the popliteal vein (r = 0.78, P < 0.0001). Combination of an optimal cut-off point of 0.2 for FI and 2.9 for RI improved the ability to discriminate early from advanced CVI, with a sensitivity of 94% and a specificity of 86%. CONCLUSIONS: These results suggest that FI and RI, as measured by NIRS, may be promising parameters for discriminating early CVI from advanced CVI. SN - 1532-2165 UR - https://www.unboundmedicine.com/medline/citation/20227896/Advanced_chronic_venous_insufficiency_is_associated_with_increased_calf_muscle_deoxygenation_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1078-5884(10)00109-7 DB - PRIME DP - Unbound Medicine ER -