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Reproducibility of Duplex Ultrasonography and Air Plethysmography Used for the Evaluation of Chronic Venous Insufficiency

Department of Vascular Sciences and Medicine, Monash University and Southern Health, Melbourne, Victoria, Australia (A.M.A., J.D.C., B.P.M.); and Department of Cardiology, The Wesley Vascular Centre, Brisbane, Queensland, Australia (A.Z.R.).

Address correspondence and reprint requests to Barry McGrath, MD, Department of Vascular Sciences and Medicine, Monash University and Southern Health, Dandenong Hospital, Dandenong, Melbourne, Victoria 3175, Australia. E-mail: barry.mcgrath{at}med.monash.edu.au

Objective. The purpose of this study was to determine the reproducibility of measurements on duplex ultrasonography (DU) and air plethysmography (APG) in subjects with post-thrombotic syndrome. Methods. Duplex ultrasonography and APG were used to measure indices of lower limb venous reflux in 15 limbs with a history of deep vein thrombosis and evidence of venous insufficiency as diagnosed by ultrasonography. Three limbs were in class 0; 4 were in classes 1 to 3; and 8 were in classes 4 to 6, according to clinical, etiologic, anatomic, and pathophysiologic clinical classification. Duplex ultrasonography was performed 3 times on the same day, and venous diameter, area, peak reflux velocity, reflux flow volume, and reflux duration measurements were obtained. Air plethysmography was performed on 2 days, 7 to 10 days apart, with 1 measurement on the first day and 2 measurements on the second day. Values obtained from APG included outflow fraction, venous filling index, ejection fraction, and residual volume fraction. The measurements were performed by a vascular technologist blinded to the previous test results. One-way analysis of variance, the Student paired t test, and Bland-Altman plots were used to examine the statistical differences of the DU and APG parameters for all measurements. Results. The mean coefficient of variation for within-subject measurements of all DU and APG parameters measured was less than 10%. Bland-Altman plots showed that there were no apparent trends with increasing values over a wide range for any of the DU parameters, nor were there any for the APG parameters. Conclusions. Under ideal conditions, when measured by a highly trained technologist, both DU and APG showed satisfactory reproducibility.

Key Words: air plethysmography • chronic venous insufficiency • duplex ultrasound • reproducibility

Abbreviations: ANOVA, analysis of variance • APG, air plethysmography • CEAP, clinical, etiologic, anatomic, and pathophysiologic • CV, coefficient of variation • CVI, chronic venous insufficiency • DU, duplex ultrasonography • DVT, deep vein thrombosis • EF%, ejection fraction • OF%, outflow fraction • RC, repeatability coefficient • RV, residual volume • RVF%, residual volume fraction • VFI, venous filling index

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