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Report of the Meeting of the Venous Forum on Friday 30th October 1987 at the Royal Society of Medicine, London

The Autumn Meeting of the Venous Forum was held on Friday 30th October at the Royal Society of Medicine under the Chairmanship of Mr F.B. Cockett. The first session, on Diagnostic Techniques was chaired by Mr J.H. Scurr. Mr J.F. Lancaster (Southmead Hospital, Bristol) reported some preliminary work on laser Doppler velocimetry (LDV). Differences in LDV waveforms were found between ulcerated and non-ulcerated limbs and between supine and dependent positions. The LDV waveform supposedly represents vasomotor activity. Correlation was found with venous reflux measured by photoplethymagraphy. The technique was suggested as another method of diagnosing venous reflux. Miss Lucarotti (Southmead Hospital, Bristol) reported a prospective study of 20 patients with leg ulcers to see if measurements of transcutaneous oximetry ('I'cPo2) , laser Doppler velocimetry (LDV) and arterial Doppler index (01) could predict healing. Results up to 12 weeks showed a significant inverse correlation of LDV and DI. The inverse relationship for I.DV is supposed to reflect infection or deranged healing in refractory ulcers. Mr K.G. Burnand (St Thomas' Hospital, London) and Dr I.HJ. Bourne (London) criticised the work for short follow-up. In the 12 weeks only a small number of ulcers had actually healed. Mr S. Vasdekis gave the first of two papers from St Mary's Hospital, London on Duplex scanning. His paper compared clinical examination, Doppler ultrasound and Duplex scanning in predicting the level of termination of the short saphenous vein (SSV) in the popliteal vein. Scores for accuracy to within ± 2 cm were 56% for clinical examination, 64% for Doppler ultrasound and 86% for Duplex scan. Hence Duplex Scanning was advocated particularly as it allowed a small 2-cm skin incision to approach the saphenopoplitealjunction. Mr B.J. Pardy (Newham Hospital, London) and Mr J. Scurr (Middlesex Hospital, London) were concerned that an accuracy of 86% was sufficient to justify such a small incision. Mr G.H. Jantet (Eating Hospital, London) was further concerned about the safety of approaching the saphenopopliteal junction through such a small incision. Furthermore, only a few surgeons have ready access to a Duplex scanner. Mr P.O. Coleridge Smith (Middlesex Hospital, London) reported a study afchanges in diameter of deep calfveins during operation. Distension does occur and may be a factor in thrombosis. Using high resolution ultrasound imaging it was shown that moving the limb from supine to dependent increased distension pre-operatively and aiter induction of anaesthesia. By the end of the operation there was no parallel increase because the veins Were already fully distended. Mr I.G. Schraibman (Rochdale) questioned the influence of positive pressure ventilation. Mr Coleridge Smith replied that the numbers were still too small to measure this, or the effect of pharmacological influences.