A Comparison of Light Reflection Rheography and Duplex Scanning
A Comparison of Light Reflection Rheography and Duplex Scanning
Light reflection rheography is a noninvasive, cost-effective, investigative tool for assessing patients who have chronic venous insufficiency (CVI). Duplex scanning is considered the gold standard for diagnosing venous insufficiency as it provides greater detail and accuracy of results. The aim of this study was to compare, retrospectively, the results of light reflection rheography (LRR) with those of Duplex scans in patients with CVI in order to determine the sensitivity of the LRR test as a screening method. The results following investigation of 42 patients attending the leg ulcer clinic at the Churchill Hospital, Oxford, were studied retrospectively. Their ages ranged from 35 to 94 years (mean 66.7 years). LRR had been carried out routinely as part of the initial leg ulcer assessment in the clinic. LRR helps to assess the competency of the leg veins by measuring venous refill time, thereby helping to determine whether an ulcer is venous in etiology. Duplex ultrasonography is carried out at the vascular laboratory at the John Radcliffe Hospital, Oxford, by skilled vascular scientists. Referral of all leg ulcer patients for Duplex scanning is not done routinely as this test is expensive, time consuming, and entails patients being placed on a waiting list for this investigation. Retrospective analysis showed that the 42 patients included in this study had been referred subsequently for Duplex ultrasonography for further confirmation of their diagnosis and/or suitability for surgery. The time lapse between the initial LRR test and subsequent Duplex scans ranged from 2 months to 8 years. Shortened refilling times were observed on LRR, and venous reflux was confirmed by Duplex scanning in 41 patients (97.6%). One patient with an abnormal LRR showed normal Duplex scan results. Due to the large number of patients presenting with CVI, routine use of Duplex is both expensive and time consuming. Since the LRR results show a high degree of sensitivity, this investigation could be used as a screening method in conjunction with a clinical assessment in determining the proportion of patients likely to require Duplex scanning for further confirmation of their diagnosis and/or suitability for surgery.
Venous ulcers constitute the majority of all leg ulcers. Venous disease accounts for 1 to 2 percent of the healthcare budgets of European countries. Early signs of chronic venous insufficiency (CVI) are varicose veins and acute lipodermatosclerosis. Progressive changes of CVI include brown hyperpigmentation of the skin caused by extravasation of red blood cells into the dermis following venous hypertension. Dependent edema eventually develops because of fluid leakage from local capillaries. Duplex ultrasound has had a considerable impact on the diagnosis and management of chronic venous disease. Duplex scanning has, therefore, become the gold standard for demonstrating the anatomy of the lower limb and confirming venous reflux in such patients.
Light reflection rheography (LRR) is performed routinely in the authors' leg ulcer clinic as part of the standard leg ulcer assessment in conjunction with a clinical examination to confirm the presence or absence of venous insufficiency. This information is vital in order to plan further management of the patient and to prevent inappropriate compression of the legs in cases where the ulcer is not venous in etiology. All patients are not referred routinely for Duplex ultrasonography. Only patients whose diagnosis needed to be further clarified or those patients who could potentially benefit from vascular surgery were subsequently referred.
Duplex scanning is an expensive, time-consuming investigation performed by skilled personnel and entails a waiting list for patients to have this investigation. Thus, a new form of screening for venous disease of the legs is appropriate.
The aim of this study was to compare, retrospectively, LRR with Duplex ultrasound results that had been performed on a group of patients who attended the leg ulcer clinic to determine the sensitivity of the LRR test as a screening method in diagnosing patients with venous ulcers.
Light reflection rheography is a noninvasive, cost-effective, investigative tool for assessing patients who have chronic venous insufficiency (CVI). Duplex scanning is considered the gold standard for diagnosing venous insufficiency as it provides greater detail and accuracy of results. The aim of this study was to compare, retrospectively, the results of light reflection rheography (LRR) with those of Duplex scans in patients with CVI in order to determine the sensitivity of the LRR test as a screening method. The results following investigation of 42 patients attending the leg ulcer clinic at the Churchill Hospital, Oxford, were studied retrospectively. Their ages ranged from 35 to 94 years (mean 66.7 years). LRR had been carried out routinely as part of the initial leg ulcer assessment in the clinic. LRR helps to assess the competency of the leg veins by measuring venous refill time, thereby helping to determine whether an ulcer is venous in etiology. Duplex ultrasonography is carried out at the vascular laboratory at the John Radcliffe Hospital, Oxford, by skilled vascular scientists. Referral of all leg ulcer patients for Duplex scanning is not done routinely as this test is expensive, time consuming, and entails patients being placed on a waiting list for this investigation. Retrospective analysis showed that the 42 patients included in this study had been referred subsequently for Duplex ultrasonography for further confirmation of their diagnosis and/or suitability for surgery. The time lapse between the initial LRR test and subsequent Duplex scans ranged from 2 months to 8 years. Shortened refilling times were observed on LRR, and venous reflux was confirmed by Duplex scanning in 41 patients (97.6%). One patient with an abnormal LRR showed normal Duplex scan results. Due to the large number of patients presenting with CVI, routine use of Duplex is both expensive and time consuming. Since the LRR results show a high degree of sensitivity, this investigation could be used as a screening method in conjunction with a clinical assessment in determining the proportion of patients likely to require Duplex scanning for further confirmation of their diagnosis and/or suitability for surgery.
Venous ulcers constitute the majority of all leg ulcers. Venous disease accounts for 1 to 2 percent of the healthcare budgets of European countries. Early signs of chronic venous insufficiency (CVI) are varicose veins and acute lipodermatosclerosis. Progressive changes of CVI include brown hyperpigmentation of the skin caused by extravasation of red blood cells into the dermis following venous hypertension. Dependent edema eventually develops because of fluid leakage from local capillaries. Duplex ultrasound has had a considerable impact on the diagnosis and management of chronic venous disease. Duplex scanning has, therefore, become the gold standard for demonstrating the anatomy of the lower limb and confirming venous reflux in such patients.
Light reflection rheography (LRR) is performed routinely in the authors' leg ulcer clinic as part of the standard leg ulcer assessment in conjunction with a clinical examination to confirm the presence or absence of venous insufficiency. This information is vital in order to plan further management of the patient and to prevent inappropriate compression of the legs in cases where the ulcer is not venous in etiology. All patients are not referred routinely for Duplex ultrasonography. Only patients whose diagnosis needed to be further clarified or those patients who could potentially benefit from vascular surgery were subsequently referred.
Duplex scanning is an expensive, time-consuming investigation performed by skilled personnel and entails a waiting list for patients to have this investigation. Thus, a new form of screening for venous disease of the legs is appropriate.
The aim of this study was to compare, retrospectively, LRR with Duplex ultrasound results that had been performed on a group of patients who attended the leg ulcer clinic to determine the sensitivity of the LRR test as a screening method in diagnosing patients with venous ulcers.
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