Comparison of Clinical and Photoplethysmographic Assessment of Venous Insufficiency

Objective: To assess the concordance between clinical and photoplethysmographic evaluation of venous insufficiency. Design: Comparison of two methods of evaluation of venous insuffiency in randomly selected patients. Setting: The Vascular Institute, Shaare Zedek Hospital, Jerusalem, Israel. Patients: Four hundred patients selected at random from a pool of 3000 patients referred to the vascular institute for suspected venous insufficiency. Interventions: Each of the 800 legs was evaluated clinically, by Trendelenburg testing, and by venous reflux photoplethysmographv (VPPG). Results: Of 230 legs without clinical evidence of venous insufficiency (including Trendelenburg testing), 214 (93%) were also normal by VPPG. However, of 359 legs with clinical evidence of venous insufficiency, only 178 (50%) were so confirmed by VPPG. Of 135 legs considered to have insufficiency of the deep venous system (DVI) by clinical criteria alone, only 31 (23%) were confirmed to have DVI by VPPG, and 49 (36%) were found by VPPG to have insufficiency of only the superficial system. Conclusions: Reliance upon clinical assessment alone is inadequate for distinguishing between insufficiency of the deep and superficial or perforating venous systems. Assessment by VPPG may identify many patients with dermatologic changes "typical of DVI" who may benefit from superficial venous surgery.