The Value of Light Reflection Rheography for the Diagnosis of Superficial Venous Insufficiency: A Study in Patients with Primary Varicose Veins and in Workers with a Standing Occupation

Abstract

Objective: To study the value of light reflection rheography (LRR) as a diagnostic tool in subjects with varicose veins and venous insufficiency. Design: A prospective study comparing patients and workers with an occupation necessitating standing. Setting: Departments of Dermatology and Vascular Surgery, University Hospital VU, Amsterdam, The Netherlands and several manufacturing plants throughout the country. Subjects: Group I: 123 patients (168 legs) with a history of primary varicose veins attending the outpatient clinic; Group II: 374 male workers (748 legs) with an occupation necessitating standing. Methods: A questionnaire on venous disorders was administered, followed by clinical investigation, continuous-wave (c/w) Doppler ultrasound and LRR examination. LRR measurements were performed above the medial malleolus. A refilling time of at least 25 s after 10 dorsiflexions at the ankle was considered normal. In the case of shorter refilling times the procedure was repeated with a tourniquet above the probe. Normalization of the refilling time indicates an incompetent superficial venous system and a normal deep system. If there was no change we concluded deep venous insufficiency was present. Furthermore, in group I, duplex investigation of the venous system was performed. Main outcome measures: The diagnostic conclusions of the LRR measurements were compared with the diagnosis based on duplex investigation (group I) and clinical examination combined with c/w Doppler investigation (group II). Results: Group I: duplex investigation showed 156 cases of superficial venous insufficiency; LRR, 33. Sensitivity of LRR: 20%. Group II: Clinical and c/w Doppler examination showed 189 cases of superficial venous reflux; LRR, 29. Sensitivity of LRR: 7%. Conclusion: LRR has no apparent additive value in diagnosing superficial varicose veins in patients with a history of primary varicosities nor in screening a population for the presence of venous insufficiency.