The Predictive Value of Haemodynamic Assessment in Chronic Venous Leg Ulceration

M. S. Gohel; J. R. Barwell; B. P. Heather; J. J. Earnshaw; D. C. Mitchell; M. R. Whyman; K. R. Poskitt

doi:10.1016/j.ejvs.2006.11.039

The Predictive Value of Haemodynamic Assessment in Chronic Venous Leg Ulceration

M. S. Gohel
, J. R. Barwell
, B. P. Heather
, J. J. Earnshaw
, D. C. Mitchell
, M. R. Whyman
, K. R. Poskitt^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

12 Citations (Scopus)

Abstract

Objectives: The aim of this study was to assess the value of PPG in predicting healing and recurrence in patients with chronic venous ulceration. Methods: 500 patients with open or recently healed venous ulceration were treated with either multilayer compression or compression plus superficial venous surgery and followed up in specialist clinics as part of a clinical study. At initial assessment, VRT was measured using PPG with and without a below-knee tourniquet inflated to 80 mmHg to occlude superficial veins. Legs were stratified into groups with VRT <11 s, 11-20 s and >20 s and comparison of healing and recurrence rates between these groups was performed. Results: VRT measurements were not achieved in 117 patients, primarily due to ankle stiffness. Of the remaining 383 patients, VRT without tourniquet did not correlate with ulcer healing (p = 0.26, 0.40) or recurrence (p = 0.20, 0.79, Log rank test) for legs treated with compression or compression plus surgery respectively. However, VRT readings taken with a below-knee tourniquet were predictive of ulcer healing (p < 0.01) and recurrence (p = 0.05, Log-rank test). The correlation was greatest for healing in legs treated with compression alone, where 24 week healing rates were 62%, 73% and 92% for legs with VRTs with tourniquet <11 s, 11-20 s and >20 s respectively (p < 0.01, Log rank test). For legs treated with surgery, 1 year recurrence rates were 24%, 10% and 3% for groups with VRTs with tourniquet <11 s, 11-20 s and >20 s respectively (p = 0.03, Log rank test). Conclusions: Digital PPG assessment may predict ulcer healing and recurrence, but only by using a below-knee tourniquet. This information could aid the selection of patients with venous ulceration most likely to benefit from superficial venous surgery.

Original language	English
Pages (from-to)	742-746
Number of pages	5
Journal	European Journal of Vascular and Endovascular Surgery
Volume	33
Issue number	6
DOIs	https://doi.org/10.1016/j.ejvs.2006.11.039
Publication status	Published - Jun 2007
Externally published	Yes

Bibliographical note

Funding Information:
The authors would like to thank C Wakely, J Minor, K Harvey and A Sassano (Vascular Scientists) for performing PPG and venous duplex assessments; M Taylor, C Davies, G Woolfrey, G Turton, R Elley and J Waldron (Gloucestershire Leg Ulcer Service) for the assistance in the assessment and follow-up of patients and Mr C Foy (Medical Statistician). The ESCHAR study was funded by The NHS Executive South and West Research and Development Directorate, Southmead Hospital Research Foundation and the Medical Research Council.

Keywords

Chronic venous ulceration
Haemodynamic assessment
Photoplethysmography
Superficial venous surgery
Venous refill time

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10.1016/j.ejvs.2006.11.039

Cite this

@article{c544b4d6a3f54e329545d05f2b7d32f1,

title = "The Predictive Value of Haemodynamic Assessment in Chronic Venous Leg Ulceration",

abstract = "Objectives: The aim of this study was to assess the value of PPG in predicting healing and recurrence in patients with chronic venous ulceration. Methods: 500 patients with open or recently healed venous ulceration were treated with either multilayer compression or compression plus superficial venous surgery and followed up in specialist clinics as part of a clinical study. At initial assessment, VRT was measured using PPG with and without a below-knee tourniquet inflated to 80 mmHg to occlude superficial veins. Legs were stratified into groups with VRT <11 s, 11-20 s and >20 s and comparison of healing and recurrence rates between these groups was performed. Results: VRT measurements were not achieved in 117 patients, primarily due to ankle stiffness. Of the remaining 383 patients, VRT without tourniquet did not correlate with ulcer healing (p = 0.26, 0.40) or recurrence (p = 0.20, 0.79, Log rank test) for legs treated with compression or compression plus surgery respectively. However, VRT readings taken with a below-knee tourniquet were predictive of ulcer healing (p < 0.01) and recurrence (p = 0.05, Log-rank test). The correlation was greatest for healing in legs treated with compression alone, where 24 week healing rates were 62\%, 73\% and 92\% for legs with VRTs with tourniquet <11 s, 11-20 s and >20 s respectively (p < 0.01, Log rank test). For legs treated with surgery, 1 year recurrence rates were 24\%, 10\% and 3\% for groups with VRTs with tourniquet <11 s, 11-20 s and >20 s respectively (p = 0.03, Log rank test). Conclusions: Digital PPG assessment may predict ulcer healing and recurrence, but only by using a below-knee tourniquet. This information could aid the selection of patients with venous ulceration most likely to benefit from superficial venous surgery.",

keywords = "Chronic venous ulceration, Haemodynamic assessment, Photoplethysmography, Superficial venous surgery, Venous refill time",

author = "Gohel, \{M. S.\} and Barwell, \{J. R.\} and Heather, \{B. P.\} and Earnshaw, \{J. J.\} and Mitchell, \{D. C.\} and Whyman, \{M. R.\} and Poskitt, \{K. R.\}",

note = "Funding Information: The authors would like to thank C Wakely, J Minor, K Harvey and A Sassano (Vascular Scientists) for performing PPG and venous duplex assessments; M Taylor, C Davies, G Woolfrey, G Turton, R Elley and J Waldron (Gloucestershire Leg Ulcer Service) for the assistance in the assessment and follow-up of patients and Mr C Foy (Medical Statistician). The ESCHAR study was funded by The NHS Executive South and West Research and Development Directorate, Southmead Hospital Research Foundation and the Medical Research Council. ",

year = "2007",

month = jun,

doi = "10.1016/j.ejvs.2006.11.039",

language = "English",

volume = "33",

pages = "742--746",

journal = "European Journal of Vascular and Endovascular Surgery",

issn = "1078-5884",

publisher = "W.B. Saunders Ltd",

number = "6",

}

TY - JOUR

T1 - The Predictive Value of Haemodynamic Assessment in Chronic Venous Leg Ulceration

AU - Gohel, M. S.

AU - Barwell, J. R.

AU - Heather, B. P.

AU - Earnshaw, J. J.

AU - Mitchell, D. C.

AU - Whyman, M. R.

AU - Poskitt, K. R.

N1 - Funding Information: The authors would like to thank C Wakely, J Minor, K Harvey and A Sassano (Vascular Scientists) for performing PPG and venous duplex assessments; M Taylor, C Davies, G Woolfrey, G Turton, R Elley and J Waldron (Gloucestershire Leg Ulcer Service) for the assistance in the assessment and follow-up of patients and Mr C Foy (Medical Statistician). The ESCHAR study was funded by The NHS Executive South and West Research and Development Directorate, Southmead Hospital Research Foundation and the Medical Research Council.

PY - 2007/6

Y1 - 2007/6

N2 - Objectives: The aim of this study was to assess the value of PPG in predicting healing and recurrence in patients with chronic venous ulceration. Methods: 500 patients with open or recently healed venous ulceration were treated with either multilayer compression or compression plus superficial venous surgery and followed up in specialist clinics as part of a clinical study. At initial assessment, VRT was measured using PPG with and without a below-knee tourniquet inflated to 80 mmHg to occlude superficial veins. Legs were stratified into groups with VRT <11 s, 11-20 s and >20 s and comparison of healing and recurrence rates between these groups was performed. Results: VRT measurements were not achieved in 117 patients, primarily due to ankle stiffness. Of the remaining 383 patients, VRT without tourniquet did not correlate with ulcer healing (p = 0.26, 0.40) or recurrence (p = 0.20, 0.79, Log rank test) for legs treated with compression or compression plus surgery respectively. However, VRT readings taken with a below-knee tourniquet were predictive of ulcer healing (p < 0.01) and recurrence (p = 0.05, Log-rank test). The correlation was greatest for healing in legs treated with compression alone, where 24 week healing rates were 62%, 73% and 92% for legs with VRTs with tourniquet <11 s, 11-20 s and >20 s respectively (p < 0.01, Log rank test). For legs treated with surgery, 1 year recurrence rates were 24%, 10% and 3% for groups with VRTs with tourniquet <11 s, 11-20 s and >20 s respectively (p = 0.03, Log rank test). Conclusions: Digital PPG assessment may predict ulcer healing and recurrence, but only by using a below-knee tourniquet. This information could aid the selection of patients with venous ulceration most likely to benefit from superficial venous surgery.

AB - Objectives: The aim of this study was to assess the value of PPG in predicting healing and recurrence in patients with chronic venous ulceration. Methods: 500 patients with open or recently healed venous ulceration were treated with either multilayer compression or compression plus superficial venous surgery and followed up in specialist clinics as part of a clinical study. At initial assessment, VRT was measured using PPG with and without a below-knee tourniquet inflated to 80 mmHg to occlude superficial veins. Legs were stratified into groups with VRT <11 s, 11-20 s and >20 s and comparison of healing and recurrence rates between these groups was performed. Results: VRT measurements were not achieved in 117 patients, primarily due to ankle stiffness. Of the remaining 383 patients, VRT without tourniquet did not correlate with ulcer healing (p = 0.26, 0.40) or recurrence (p = 0.20, 0.79, Log rank test) for legs treated with compression or compression plus surgery respectively. However, VRT readings taken with a below-knee tourniquet were predictive of ulcer healing (p < 0.01) and recurrence (p = 0.05, Log-rank test). The correlation was greatest for healing in legs treated with compression alone, where 24 week healing rates were 62%, 73% and 92% for legs with VRTs with tourniquet <11 s, 11-20 s and >20 s respectively (p < 0.01, Log rank test). For legs treated with surgery, 1 year recurrence rates were 24%, 10% and 3% for groups with VRTs with tourniquet <11 s, 11-20 s and >20 s respectively (p = 0.03, Log rank test). Conclusions: Digital PPG assessment may predict ulcer healing and recurrence, but only by using a below-knee tourniquet. This information could aid the selection of patients with venous ulceration most likely to benefit from superficial venous surgery.

KW - Chronic venous ulceration

KW - Haemodynamic assessment

KW - Photoplethysmography

KW - Superficial venous surgery

KW - Venous refill time

UR - https://www.scopus.com/pages/publications/34247571832

U2 - 10.1016/j.ejvs.2006.11.039

DO - 10.1016/j.ejvs.2006.11.039

M3 - Article

C2 - 17275361

AN - SCOPUS:34247571832

SN - 1078-5884

VL - 33

SP - 742

EP - 746

JO - European Journal of Vascular and Endovascular Surgery

JF - European Journal of Vascular and Endovascular Surgery

IS - 6

ER -

The Predictive Value of Haemodynamic Assessment in Chronic Venous Leg Ulceration

Abstract

Bibliographical note

Keywords

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