Photoplethysmography reexamined: lack of correlation with duplex scanning

In a prospective study a comparison was made between the results of photoplethysmography and ultrasonic duplex scanning in 151 consecutive legs with swelling, aching, and suspected venous insufficiency. Thirty-four percent of the legs had a history of previous deep venous thrombosis, 26% had undergone previous superficial vein surgery, and 11% had active or healed ulceration. Photoplethysmographic findings were normal in 86 (57%) of these legs and indicated deep venous disease in 33 (22%). With duplex scanning, incompetent vein segments were found in 140 legs (93%). The kappa coefficient of agreement between the result, classified as either normal, superficial disease only, or deep incompetence, was 0.12 +/- 0.06. In legs with superficial disease, the number of incompetent levels was no greater in legs with abnormal results of photoplethysmography than in legs with normal results of photoplethysmography. In general, an abnormal photoplethysmographic result is related to multilevel reflux and the presence of visible skin changes. Photoplethysmography had the same value, in these patients, to predict the presence of multilevel reflux as had inspection of the skin of the goiter area. These results do not warrant the continued use of photoplethysmography for surgical decision making in patients with suspected venous insufficiency.