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1 air plethysmography APG air plethysmography APG follow-up APGChristopoulos Nicolaides venous filling index ejection fraction 63APG Air plethysmography air plethysmography APG Table Table 1 Table 2 1 Tel: Kistner 3 Fig Table 3 Kistner mg/kg Kistner Fig. 2 CHF-P20Q 5.2mm Fig F 110cm 13
2 11 4 Table 1 Patient characteristics Table 2 Characteristics of ulcers and erosion 50ml Valsalva INR APG ACImedical APG Fig. 1 Descending venogram case 5 Left photo pre-ope. shows the venous reflux of Kistner grade 3. Right photo post-ope. shows the venous reflux of Kistner grade follow-up Kaplan-Mayer Kistner Kistner 3 Fig APG Venous Filling Index VFI 4.8ml/sec 2ml/ 14
3 Table 3 Operation procedures sec VFI 90 Ejection Fraction EF 61 40EF Residual Volume Fraction RVF RVF 10 Christopoulos Nicolaides 2, 3 VFI EF APG Fig Fig. 5 APG Fig. 2 Scheme and intraoperative photo case 3 right of valvuloplasty procedure A longitudinal venous incision dose not extend the valve level. Raju 4, 5 1 Kistner Kistner 3 15
4 11 4 Fig. 3 Intraoperative angioscopy case 2 Right photo shows improvement of the prolapse in the leaflets. Fig. 4 Results of descending venogram Fig. 5 Results of air plethysmography A double circle shows postoperative values. A single circle shows preoperative values. Note the double circle in the 63% area. This patient had reccurrence of leg ulcer after this examination. The number of percentage in this figure revealed incidence of leg ulcer according to Christopoulos and Nicolaides s paper 2, 3 EF: ejection fraction of calf muscle, VFI: venous filling index, N: normal strip test APG Christopoulos Nicolaides VFI EF
5 APG Raju internal sleeve external 5 external 1 internal Raju initial adventitial dissection 6 Kistner internal 1 APG Kistner, R. L.: Deep venous reconstruction Inter. Angio., 4: , Christopoulos, D. and Nicolaides, A. N.: Air plethysmography. In Surgical management of venous disease. Raju, S. and Villavicencio, J. L., eds. 1997, Williams & Wilkins, pp Christopoulos, D., Nicolaides, A. N., Cook, A., et al.: Pathogenesis of venous ulceration in relation to the calf muscle pump function. Surgery, 106: , Raju, S.: Venous valve reconstruction. In Surgical management of venous disease. Raju, S. and Villavicencio, J. L., eds. 1997, Williams & Wilkins, pp Raju, S., Fredericks, R. K., Neglen, P. N., et al.: Durability of venous valve reconstruction techniques for "primary" and postthrombotic reflux. J. Vasc. Surg., 23: , Raju, S. and Hardy, J. D.: Technical options in venous valve reconstruction. Am. J. Surg., 173: , Outcome of Valvuloplasty with Additional Procedures for Chronic Venous Insufficiency and Estimation of Venous Function by Air Plethysmography Naoki Hayashida 1, Hirokazu Murayama 1, Kouzou Matsuo 1, Yoko Pearce 1, Souichi Asano 1, Yukio Ohashi 1, Mitsuru Nakaya 2, Masahisa Masuda 2, Nobuyuki Nakajima 2 and Katsuhiko Tatsuno 1 1 Department of Cardiovascular Surgery, Chiba Cardiovascular Center 2 The First Department of Surgery, Chiba University School of Medicine Key words: Chronic venous insufficiency, Venous valvuloplasty, Air plethysmography, Leg ulcer Valvuloplasty with additional procedures high ligation and stripping of large saphenous vein etc. was performed in 8 limbs of 7 patients with chronic venous insufficiency between February 1997 and March They consisted of 2 men and 5 women with a mean age of 61 years. Air plethysmography has been used to evaluate venous function since Recurrence of a leg ulcer was found in one case at the 15th postoperative month during the follow-up period mean, 23 months. The ulcer-free rate was 100% and 75% at 1 and 2 years, respectively. One patient suffered the complication of deep vein thrombosis postoperatively. Christopolous and Nicolaides revealed that, in cases which the venous filling index and the ejection fraction of the calf muscle suggested the presence of the leg ulceration, there was indeed a high incidence 63% of leg ulceration. This result suggests that APG can predict ulcer recurrence after valvuloplasty. Jpn. J. Vasc. Surg., 11: ,
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