What is the value of APG in the diagnosis of iliac vein obstruction?

Abstract

It looks like treatment of central venous obstruction has become easy since the introduction of iliac stenting procedures. However, this treatment includes a minimum period of anticoagulation and the stent is for life. Furthermore, there are no accepted criteria for evaluation of the results. It is difficult also to establish robust indications of stenting especially since 25 % of the normal population have a diameter reduction > 50 % in the left iliac vein.

Another confounding fact is that chronic venous insufficiency (CVI) can be the consequence of multiple simultaneous pathologies, like varicose veins, obstruction and deep venous reflux. Thus, the treatment of one of these may not have a significant clinical effect if the cause is multifactorial.

Air Plethysmography (APG) is an objective, non-invasive and patient independent investigation of venous drainage. This includes gravitational filling (venous filling index) and elevation emptying (venous drainage index) all in the same test. This investigation should be performed as a screening test, prior to deep venous stenting and also as a follow-up instrument.

Key words

APG - air-plethysmography - venous obstruction - iliac vein stenting - venous drainage index

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