A Study of the Routine Use of Venous Photoplethysmography in a One-Stop Vascular Surgery Clinic

Abstract

INTRODUCTION The decision to offer surgical treatment for varicose veins should be based on objective evidence of venous dysfunction and not only the subjective appearance or the reported symptoms. Special tests are required to identify the sub-group of patients with functional superficial venous reflux accurately. The initial test should be simple, cheap, objective, sensitive and easy to perform by a wide range of staff in order to screen out patients without reflux. The final test should be anatomically specific to identify the appropriate surgical procedure. The aim of this study was to test the feasibility of using photoplethysmography (PPG) as the initial test as part of a one-stop vascular clinic assessment protocol. PATIENTS AND METHODS All patients referred to one consultant over a 68-week period were assessed using standard practice for the first 22 weeks and with an objective assessment protocol based on PPG for the subsequent 46 weeks. RESULTS A total of 347 out-patient appointments for patients with venous disease were booked: 239 (69%) were new referrals. Of the new patients, 59% were CEAP C2/3 and 23% were CEAP C4-6. The introduction of the objective assessment protocol was associated with a reduction in patients offered surgery from 39% to 24% overall and 51% to 28% in new patients with CEAP C2. There was a corresponding increase in the number of patients discharged back to the GP from 19% to 29% overall and 17% to 32%, respectively. The number of patients referred for duplex ultrasound fell slightly from 26% to 22%. Overall, there was a significant change in practice between the two periods (χ2 = 13.3; df = 3; P = 0.004). CONCLUSIONS The introduction of an objective assessment protocol based on PPG as the initial objective test reduces the number of patients offered surgery based on objective evidence of venous dysfunction.