Online publication August 27, 2009 CVT J Jpn Coll Angiol, 2009, 49: 207 212 ambulatory venous pressure plethysmography continuous wave Doppler duplex ultrasonography 21 ambulatory venous pressure AVP 20 40 AVP 25mmHg 10 1 1 10 venous refilling time: VRT or RT 50 90 50 t/2 90 90 RT 5mmHg 1 2009 1 6 THE JOURNAL of JAPANESE COLLEGE of ANGIOLOGY Vol. 49, 2009 207
Figure 2 Recording data of digital photoplethysmography. Figure 1 Attachment of probe of digital photoplethysmography. 1 muscle pump plethysmography 2 venous occlusion plethysmography 80mmHg 3 PPG: photoplethysmography 2 3mm700 800nm 2 3cm Fig. 1 10 AVP refilling time RT 20 Fig. 2 80mmHg 2 1 2 PPG VO venous outflow 208 Vol. 49, 2009
Figure 3 Sensing cuff attachment of air plethysmography. PPG /minvo 30 / min VO Figure 4 Tip-toe exercise (APG) 4 APG: air plethysmography 35cm APG Fig. 3 50cc Fig. 3 Fig. 4 VV(venous volume)vv 90 90 VRT(venous refilling time) 90 VV 90 VRTVFI(venous filling index) Fig. 5 VFI 2ml/s VFI Harada VFI > 7ml/min 73 100 100 2 1 EV(expelled volume)fig. 5 EV Figure 5 Findings of muscle pump air plethysmography. VFI 3 5 EV 10 RV(residual venous volume) RV VV 100 RVF(residual venous Vol. 49, 2009 209
Figure 7 Findings of venous occlusion air plethysmography. Figure 6 Venous occlusion air plethysmography. fraction)fig. 5 RVFAVP 3, 5 EV Fig. 6 10 12cm 80mmHg Fig. 7 VC venous capacitance 1 V 1 one second outflow OF 1 outflow fraction at one second Kalodiki OF 1 28 95 96 92 98 6 5 1mm Ambulatory strain gauge plethysmography ASGP venoarteriolar reflex 20 60 2 1 EVASGP AVP RT 0.91EV 0.41 7 Duplex 45 210 Vol. 49, 2009
Duplex Duplex 2 0.5 8 Duplex AVP 9 AVP 10 cuff inflator/deflator Duplex VFI VO Vol. 49, 2009 Vascular Labo CVT: Clinical Vascular Technologist http://plaza.umin.ac.jp/~cvt/ 1 Gloviczki P, Pairolero PC, Toomey BJ et al: Reconstruction of large veins for nonmalignant venous occlusive disease. J Vasc Surg, 1992, 16: 750 761. 2 Harada RN, Katz ML, Comerota A: A noninvasive screening test to detect critical deep venous reflux. J Vasc Surg, 1995, 22: 532 537. 3 Criado E, Farber MA, Marston WA et al: The role of air plethysmography in the diagnosis of chronic venous insufficiency. J Vasc Surg, 1998, 27: 660 670. 4 Ting AC, Cheng SW, Wu LL et al: Air plethysmography in chronic venous insufficiency: clinical diagnosis and quantitative assessment. Angiology, 1999, 50: 831 836. 5 Nishibe T, Kudo F, Miyazaki K et al: Relationship between parameters of air plethysmography and types of superficial venous reflux in patients with primary varicose veins. Int Angiol, 2008, 27: 385 388. 6 Kalodiki E, Calahoras LS, Delis KT et al: Air plethysmography: the answer in detecting past deep venous thrombosis. J Vasc Surg, 2001, 33: 715 720. 7 Struckmann JR: Assessment of the venous muscle pump function by ambulatory strain gauge plethysmography. Methodological and clinical aspects. Dan Med Bull, 1993, 4: 460 477. 8 Sarin S, Sommerville J, Farrah J et al: Duplex ultrasonography for assessment of venous valvular function of the lower limb. Br J Surg, 1994, 81: 1591 1595. 9 Rodriguez AA, Whitehead CM, McLaughlin RL et al: Duplex-derived valve closure times fail to correlate with reflux flow volumes in patients with chronic venous insufficiency. J Vasc Surg, 1996, 23: 606 610. 10 Neglén P, Egger JF 3rd, Olivier J et al: Hemodynamic and clinical impact of ultrasound-derived venous reflux parameters. J Vasc Surg, 2004, 40: 303 310. 211
Functional Examination Norihide Sugano Division of Vascular Surgery, Department of Surgery, Tokyo Medical and Dental University Hospital Faculty of Medicine, Tokyo, Japan ambulatory venous pressure, plethysmography, continuous wave Doppler, duplex ultrasonography Venous functional examinations need to evaluate both reflux and occlusion. The invasive venous pressure measurement has been the gold standard for the venous functional test; however, non-invasive examinations are becoming more common. The Doppler examination is useful for screening the reflux, and then Duplex identifies the location of the reflux. Plethysmography offers quantification of the reflux and obstruction. It is now important that we increase the number of Clinical Vascular Technologists as soon as possible to popularize such non-invasive examinations in Japan. (J Jpn Coll Angiol, 2009, 49: 207 212) Online publication August 27, 2009 212 Vol. 49, 2009