AMBULATORY VENOUS-PRESSURE AND LEG VOLUME MEASUREMENTS BEFORE AND AFTER SURGERY FOR PRIMARY VARICOSE-VEINS

Objective: To compare clinical disability, ambulatory venous pressure (AVP) and leg volume before and after venous surgery, and to relate th e changes to those observed after one night preoperative in-hospital r est. Design: Prospective study. Setting: Department of Vascular Surger y, University Hospital, Paris, France. Subjects: Nineteen patients wit h primary varicose veins and mild chronic venous insufficiency (CVI), scheduled for venous surgery. Main outcome measures: Clinical disabili ty recorded by the analogue scale method, and leg volume and AVP measu rements. These evaluations were repeated three times: on the day befor e surgery, in the afternoon; in the early morning on the day of surger y; and 2 months after surgery, in the afternoon. Results: Varicose vei n surgery improved disability (p=0.001) and two AVP parameters: recove ry time (RT, p = 0.0049) and the calf muscle pump index (CMPI), which rose by 345% (95% confidence intervals: 29, 659). Preoperative supine rest for one night improved disability (p = 0.0016) and reduced leg vo lume (p = 0.0002). The improvements induced by surgery correlated with the changes induced by rest, for disability (p=0.016), RT (p = 0.006) and CMPI (p = 0.033). Conclusion: Surgery improves venous function in patients with primary varicose veins. AVP remains a standard method o f evaluating CVI. Combined with volumetry, it allows sensitive compari sons between different treatments. Because venous function varies grea tly with daily activity, it is imperative to standardize the times at which venous function is evaluated.