Noninvsive Diagnostic Techniques in Peripheral Vascular Disease

Lee, Han Koo; Lee, Duk Yong; Chung, Moon Sang; Won, Choong Hee

Abstract

Contrast arteriography and phlebography remain the standard diagnostic techniques for evaluation of peripheral arterial and venous diseases. However, invasive angiographic techniques involve expense, time, discomfort, and potential risks to the patient which preclude their use as routine screening and followup procedures. In order to obtain accurate, objective information to complement the clinical diagnosis of peripheral vascular diseases, many noninvasive diagnostic techniques have recently become available to the clinican. Among these techniques, photoplethysmograph (PPG), strain gauge plethysmograph (SPG), and doppler ultrasound were adopted for our study. Fourty young volunteers were studied as a control group, and twenty peripheral vascular disease patients were studied as a patient group. We obtained average values of PPGa, blood flow, maximum PRT venous reflux folw (MVRF), maximum venous outflow (MVOF), pulse reappearance time (PRT), PRT/2 and pulsatility idex(PI) for control group. Results for patient group were analysed and compared with those of control group. 1. Normal PPGa wave has a steep upslope, a relatively narrow peak, and a dicrotic wave on the downslope which is concave toward the baseline. PPGa reflected skin blood flow sensitively than any other technique. 2. Average forearm blood flow by means of SPG was 5.7±2.0, and that of calf was 3.7±1.4ml/min/100cc tissue. MVOF of forearm was 32.9±10.4, and that of calf was 18.0±7.0ml/min/100cc tissue. Blood flow measurement was not useful for detection of arterial occlusive disease, but MV OF was useful for diagnosis of deep vein thrombosis. 3. PRT, PRT/2, over shooting reaction time by means of SPG have low diagnostic value and PI by means of doppler ultrasound was useful for localization of arterial narrowing or obstruction. 4. Noninvasive diagnostic techniques including PPG, SPG and doppler ultrasound are useful for screening and follow-up procedures in diagnosis of peripheral vascular disease. They are also valuable to supplement angiographic or physical findings.