ORIGINAL ARTICLES   

Panminerva Medica 1999 March;41(1):10-14

Copyright © 2000 EDIZIONI MINERVA MEDICA

language: English

The edema tester in the evaluation of swollen limbs in venous and lymphatic disease

Cesarone M. R., Belcaro G., Nicolaides A. N., Arkans E., Laurora G., De Sanctis M. T., Incandela L.

From the Microcirculation Laboratory Cardiovascular Institute Chieti University PAP/PEA Institute, San Valentino, Pescara Angiology & Vasc. Surgery & Clinical Trial Unit Pierangeli Clinic, Pescara, Italy and Irvine Laboratory St. Mary’s Hospital and Imperial College, London, UK

Background. Edema is a ­common con­di­tion in ­most ­venous and lym­phatic dis­eases. The ACI ­edema ­testers (ET) ­have ­been devel­oped to objec­tively eval­uate the pres­ence of ­edema. Two ­types of ­testers ­have ­been devel­oped. ET1 is a ­soft ­plastic ­plate (5×2 cm) char­ac­ter­ised by two par­allel pro­tru­sions ­while the ET2 is char­ac­ter­ised by two ­lines of 7 ­holes.
Methods. The ETs are ­applied ­onto the ­internal per­i­mal­le­olar ­region ­with the pro­tru­sions/­holes in con­tact ­with the ­skin. A ­blood pres­sure ­cuff is ­applied ­over the ­area (pres­sure main­tained at 50 mmHg for a ­period ­between 1-3 min­utes). When the ­cuff is ­removed, with the ET1 ­skin ­marks are usu­ally ­just vis­ible in ­normal ­limbs (­they dis­ap­pear in a few min­utes). We ­studied 22 ­normal ­limbs, 19 ­with var­i­cose ­veins, 22 ­with ­chronic ­venous insuf­fi­ciency, 5 ­with pri­mary lym­phedema and 8 ­with ­severe ­chronic lym­phedema.
Results. In ­limbs ­with ­severe ­edema the ­whole ­length of the pro­tru­sions is vis­ible; ­with mod­erate ­edema ­only a ­part of the pro­tru­sions is vis­ible. With the ET2 ­skin ­marks are ­just vis­ible in ­normal ­limbs (­only the ­larger ­holes). Marks dis­ap­pear in a few min­utes in ­normal ­limbs ­while in ­limbs ­with ­edema the ­number of vis­ible ­holes is ­increased (in ­severe ­edema all ­holes are vis­ible). There ­were sig­nif­i­cant dif­fer­ences ­between nor­mals and ­patients (con­sid­ering ­skin ­mark ­length, ­number of vis­ible ­holes and dis­ap­pear­ance ­times).
Conclusions. The two ­testers sep­ar­ated ­patients ­with dif­ferent ­severity of ­edema due to ­chronic ­venous or lym­phatic prob­lems. In ­severe lym­phatic prob­lems all param­e­ters ­were dif­ferent (p<0.02) ­from ­those ­observed in ­venous dis­ease. A repro­du­cibility ­study indi­cated ­that the ET ­tests ­have min­imal vari­a­tions in ­mark vis­ibility or ­length or ­hole num­bers (for the ET2).