Detection and quantitation of venous leg edema with the edema ruler and ultrasound

Objective: Lower extremity edema is characteristic of C3 chronic venous disease. We developed a new clinical and duplex ultrasound (DUS) methodology for the detection and quantification of leg edema and prospectively evaluated its usefulness. Methods: Forty-seven venous patients (94 legs) were evaluated for ankle edema using an Edema Ruler^TM and DUS using a modified Suehiro grading scale. Results: Interobserver reliability for the use of the Edema Ruler^TM was 0.985 (p < .001) and 0.883 (p < .001) for the Modified Suehiro Grade. The Edema Ruler^TM had stronger significant correlations with Edema rVCSS (0.842; p < .001) compared to DUS: (0.474;p < .001) with Edema rVCSS. There were significant differences between the edema pitting depth in CEAP classification of C1 and C2 compared to C3, C4a, and C4c. DUS analysis only had significant differences between CEAP classification C2 and C4a. Conclusions: The Edema Ruler^TM provides a quantitative measurement of lower extremity edema with high reliability which can be easily integrated into clinical practice. While both methods had good inter-observer reliability, the Edema Ruler^TM had stronger correlations to Edema rVCSS and showed significant differences in pitting depths between lower CEAP scores (C1-2) compared to higher CEAP scores (C3-4c).