Valitrack study: Objective evaluation of medical compression wearing time and patient activity with the Accutrack® by Sigvaris Group sensor.

INTRODUCTION: Objective measurement of compliance is mandatory to evaluate therapeutic effects and clinical benefits of medical compression stockings. This Valitrack study evaluates the Accutrack sensor equipped with an accelerometer. The evaluation is done under controlled and free conditions and during washing. RESULTS: Global accordance results are excellent: Sensitivity (98.6%) and specificity (95.2%) and 92% of patients are not disturbed by the sensors when putting on the stockings. DISCUSSION: Thanks to its specificities one sensor per patient is sufficient. Its sensitivity distinguishes still and active positions. Only hand washing remains a false positive. The Accutrack sensor objectively measures compliance and will not be a bias because 96% of patients forget it. CONCLUSIONS: Objective compliance measurement with Accutrack allows us to evaluate the efficacity of compression, the reasons of non-compliance, and the patient's actual physical activity according to its accelerometer time-stamped.

Physician interpretation of ultrasound in the evaluation of ankle edema.

OBJECTIVES: The aim of this study was to assess inter­ and intra­observer agreement of detection and grading of oedema measured by vascular physicians using ultrasonography. METHOD: In this observational study, three investigators read 113 videos of ultrasonography of the medial lower leg of 77 patients using a 15-18 MHz linear probe and reported whether oedema was present or not and, if present, to what extent. The videos were selected by the coordinator and sent every two months for a period of six months to the three investigators. Intra­ and interobserver agreements were calculated using the Fleiss Kappa coefficient, reported with their 95% confidence interval and interpreted using the Landis and Koch values. RESULTS: Inter-observer agreement as to whether oedema was present or not was 0.88 (0.77-0.98), 0.96 (0.89-1.0) and 0.91 (0.80-1.0) for the first, second and third readings, respectively. The concordance was considered to be "excellent." Inter-observer agreement as to the severity of oedema was 0.52 (0.38-0.65), 0.53 (0.39-0.66) and 0.61 (0.47-0.75) for the first, second and third readings, respectively. The concordance was "moderate". Intra-observer reliability for the diagnosis of oedema was only 0.89 (0.70-1.0), 0.93 (0.75-1.0) and 0.92 (0.74-1.0) for the first, second and third reader, respectively, which was "excellent". CONCLUSIONS: The inter-observer agreement interpreting ultrasound videos using standard probes was excellent. Only moderate agreement in grading the severity of the edema using our arbitrary criteria was shown.

Anomalous intraosseous venous drainage: Bone perforators?

Objectives Anomalous intraosseous venous drainage is a rare and almost unknown entity; only 14 cases have been reported in the literature and 4 mentioned in textbooks. We report the characteristics of 35 further cases observed in 32 patients. Method After the presentation of two cases at the congress of the French Society of Phlebology in Paris (2013), 12 colleagues joined to present a large series of so-called bone perforators observed in their practice, all identified with at least a duplex investigation. Results Thirty-two patients suffering from varicose veins and/or skin changes (C2-C6) associated with a bone perforator of the tibia (with bilateral anomalies in three) are reported: 19 females and 13 males, average age 56.9. The majority of the affected legs were symptomatic (30/35). Bone perforator was an isolated finding in 27/35 legs. In three cases, the investigations revealed that the venous reflux in the bone originated from an incompetent posterior tibial vein. Conclusions We suggest the name of "bone perforators" for an anomalous tibial intraosseous venous drainage, feeding varicose veins, and in more advanced stages lipodermatosclerosis and leg ulcers. Most of them were successfully treated with surgery or sclerotherapy.