Bloody venous pressure measurement and compartment pressure measurement

The hallmark of chronic venous insufficiency is venous hypertension. Long term venous insufficiency can result in a chronic compartment syndrome. The gold standard investigation to measure venous hypertension is an ambulatory venous pressure measurement. However, this investigation as well as the compartment pressure measurement (in patients with a suspct chronic venous compartment syndrome) has thus far never been fully standardized. Standing venous pressure is defined by the hydrostatic pressure, and is therefore dependent on a persons' height. This value lies between 80 and 100 mmHg for the average European person. While walking, venous pressure drops to at least 40 mmHg. However, in completely healthy individuals venous pressure will drop to 20 mmHg, and consequently venous refill time will be over 25 seconds. No normal values exist for the pressures in the anterior compartment of the lower leg. History, measured pressures and possible differences between left and right are important in the work up of the patient. We demonstrated a significant relation between ambulatory venous pressure measurement and skin changes listed in the international CEAP classification for venous insufficiency, which underlines the importance of the use of this classification. Duplex ultrasound of the veins has largely replaced ambulatory venous pressure measurement. However, there still are some good indications for ambulatory venous pressure measurement. For example, since patients with a post-thrombotic syndrome and an iliac-femoral vein occlusion are more frequently treated by desobstruction and stenting, ambulatory venous pressure measurement may be used to quantify the effect of this intervention. If one suspects a chronic venous compartment syndrome, the compartment pressure measurement is very helpful, because based on this investigation an eventual decompression operation may be indicated.