Recommend plethysmography for:Recommend these other technologies for:
RespondentADVTCVIPADCADADVTCVIPADCADAdditional comments
University of WashingtonNCNCNCNCNCNCNCNCEnclosed bibliography for PG, DU in arterial and venous disorders.
Penn StateYesYesYesNCDUDUSLPNCPG is essential for diabetic evaluations. Enclosed voluntary standards for Intersocietal Commission for the Accreditation of Vascular Laboratories.
University of MassachusettsNCNCNCNCNCNCNCNCEnclosed reprints on IPG and practitioner survey results.
ECRINCNCNCNCNCNCNCNCEnclosed product comparisons (performance characteristics) for DU, flowmeters, pulse oximeters.
Society of Cardiovascular/Interventional RadiologistsNoYesYesRDUDUNCDUPG has no role in ADVT. PG in CVI is controversial. DU is good in ADVT, CAD.
Rhode Island HospitalNoNoRRDUDUSLPDUOPG occasionally useful in CAD (DU and triplex are standard) and PAD (PVR and SLP are standard for initial evaluation). IPG used (but DU more sensitive) in ADVT but insensitive for CVI. DU differentiates nonocclusive and occlusive disease. PG has no role in diagnosis of venous disease.
Alexandria Hospital


No


Yes


No


No


DU


DU


SLP
DD
DU
DU
MRA

PG is useful in evaluating diabetic patient, postexercise, or reactive hyperemia. PAD is evaluated with SLP and DD, not SGP. PPG is useful for digit evaluation. DU is sensitive in selected vessels in detecting plaque/occlusive disease, postop evaluation of angioplasties, and anastamoses. Limited use in obesity, minor arterial disease, postexercise/hyperemic responses. DU has replaced PG in evaluating ADVT. High resolution compression ultrasound and color DU are highly accurate for proximal disease, but of uncertain accuracy for calf disease (as is PG). PG is occasionally useful in CVI. Usefulness of OPG in evaluating cerebral collaterals has never been demonstrated. DU has replaced all noninvasive technology for CAD. MRA may also play role.


Miami Vascular InstituteYesYesYesNCPVRPVRDDNCPVR reliably produces net flow measurement. Helpful in multisegment disease, ischemia, wound healing, postexercise testing. PG, DD are basis of assessment in PAD.
American College of Radiology

No

No

Yes

NC

DU

DU

DU
SLP
NC

PG for venous disease is passè. DU superior for ADVT (detects nonocclusive thrombi, calf thrombi, DVT). PG for PAD is valuable, but SLP is basic technique. PVR and arterial waveform analysis has limited effectiveness in multilevel disease. DU is effective in PAD triage.


University of UtahYesNCNCNCDUNCNCNCDU is superior for ADVT (detects nonocclusive thrombi, calf thrombi, and disease that mimics DVT). PG is accurate as primary diagnostic method only in proximal venous disease.
Harvard UniversityYesYesPVRNCDUDUSLPNCUtility of IPG and PRG is in symptomatic patients with AK thrombi, at high risk for PE, and requiring anticoagulants. IPG, PRG are nonquantitative and can't identify duplicate venous segments. Comparison of DU with IPG, PRG, and CV shows accuracy of DU is greater (sens, 95; spec, 97) for obstructive (symptomatic) DVT AK. In asymptomatic DVT, IPG and PRG sens <50, spec 70. IPG, PRG are insensitive to calf vein DVT (sens 30, 80 respectively). DU has greater sens (80), but no validation in asymptomatic BK DVT. Monitoring postop, asymptomatic patients with PG for detection of DVT is not recommended. DU is gold standard for evaluation of peripheral venous disease. PPG (and LRR) are best used serially in patients with CVI. PAD is best diagnosed by SLP measurements (ankle/brachial systolic pressure index). PVR is good in diabetics.
Brown UniversityNoNoNCNCDUDUNCNCContemporary assessment of the venous system, particularly in acute disease, belongs to DU. DU is much less operator-dependent than PG and can assess ancillary diseases of LE. PG can no longer be justified in clinical medicine. It is second rate and should be relegated to history books.
UCLAYesYesYesNCDUDUDUNCEnclosed bibliography. PG measured overall effect of disease, rather than site. Complete assessment that DU gives is not necessary in all patients. PG is necessary when overall functional evaluation is indicated.
Cranley Surgical Associates

Yes

Yes

Yes

NC

DU

APG
PPG
DU

DU

IPG, PRG are used in diagnosis of DVT. PVR is important in diabetics with PAD who test falsely high with SLP. APG, PPG are still considered investigational.
Electro-Diagnostic InstrumentsYesNCYesNCNCNCNCNCNC
University of MichiganYesYesNCNCNCDUNCNCPPG is good qualitative test for CVI. Will study uses of APG in CVI in quantitating venous reflux. PG is still important in evaluating the extremity as an entire physiologic unit.
St. Clares-Riverside Medical CenterNoYesYesNCDUNCNCNCPPG, APG, and SGP provide complimentary information to DU or Doppler. Ultrasound (Doppler) less effective in diabetics with stiff arterial walls. PPG and APG are superior in evaluating thoracic outlet syndrome. DU is method of choice in detecting DVT, but PPG or APG is most effective for detecting venous valvular incompetence. SGP is also used for CVI.
Morristown Memorial HospitalYesYesYesNCDUDUNCNCB-mode and DU are preferred diagnostic tests for DVT. PPG is still useful for penile and digital segmental systolic arterial pressures, venous valvular insufflation (APG is more accurate). APG will be supplanted by color DU for volumetric blood flow measurements.
ICAVLYesYesYesNCDUDUSLPNCDU, B-mode with Doppler and IPG, SGP, and APG are for primary testing in any peripheral venous disease. Continuous-wave Doppler, B-mode, and PPG may be used with primary methods. PAD studied by SLP, continuous-wave Doppler, APG, IPG, SGP, and DU and supplemented with PPG or transcutaneous oximetry.
QMED, Inc.NCYesNCNCNCNCNCNC2,500 patients have undergone LRR and CV. Mean sens 96 (range, 92-100), -NPV 96 (range, 92-100) in detecting DVT.

Abbreviations: ADVT = acute deep vein thrombosis; AK = above knee; BK = below knee; CAD = (extracranial) carotid arterial disease; CVI = chronic venous insufficiency; DD = directional Doppler wave-form analysis; DU = duplex ultrasound (B-mode plus Doppler); ICAVL = Intersocietal Commission for the Accreditation of Vascular Laboratories; MRA = magnetic resonance imaging; NC = no comment; PAD = peripheral arterial disease; PE = pulmonary embolism; PG = plethysmography; postop = postoperative(ly); PVR = pulse-volume recording (pulse wave-form analysis); R = rarely; sens = sensitivity; SLP = segmental limb pressure recordings; SPA = segmental pressure analysis; spec = specificity.

From: Plethysmography: Safety, Effectiveness, and Clinical Utility in Diagnosing Vascular Disease

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