Tourniquets Cannot Identify Superficial Venous Reflux Nor Predict the Haemodynamic Outcome of Saphenous Vein Surgery

Abstract

Objective: To evaluate the ability of tourniquets or manual venous compression to predict the haemodynamic outcome of saphenous vein surgery. Design: Prospective, observational study using colour duplex scanning and photoplethysmography (PPG) in patients undergoing saphenous vein surgery. Patients and methods: Twenty-six patients (26 limbs) undergoing saphenous vein surgery underwent colour duplex and PPG assessment before and after the application of tourniquets or manual venous compression. The effect of compression on the superficial and deep veins was assessed by colour duplex scanning. The haemodynamic effect of compression was measured using PPG 90% refill times (PPGRT90) and the results compared with the postoperative PPGRT90. Results: Pneumatic tourniquets occluded 27% of saphenous veins. Manual compression significantly lengthened PPGRT90 compared with pneumatic tourniquets but neither method could usefully predict the postoperative PPGRT90. Conclusion: Neither pneumatic tourniquets nor manual venous compression predict postoperative venous refill times. We advise caution in the interpretation of tourniquet testing.