Role of ambulatory venous pressure measurement in the assessment of venous disease

Abstract

Objectives: The gold standard assessment of venous hypertension is ambulatory venous pressure (AVP). Aims of this study were to determine the relationship of AVP with clinical severity of venous disease and whether AVP accurately identifies sites of incompetence. Methods: 117 limbs (93 subjects) underwent classification of venous signs, duplex imaging and AVP measurement. Eleven limbs had no disease, 28 had varicose veins (VVs), 45 had chronic venous insufficiency, 15 had healed ulceration, and 18 had active ulceration. Results: Mean (standard error of the mean) pressure relief index (PRI) showed a step-wise decrease from 1794 (±317) in controls to 167 (±46) in active ulcers ( P <0.001, ANOVA). PRI correlated with clinical severity of venous disease (r = -0.60, P <0.01, Pearson). Superficial reflux alone was most common in VVs (60%), deep reflux in active ulceration (11%) and combined reflux in healed ulceration (93%). Tourniquet tests showed an increase in PRI only in combined reflux ( P <0.028, ANOVA). Conclusions: AVP correlates with skin condition but is inaccurate in identifying sites of incompetence.