Rheovasography of the upper and lower extremities - what is it and who will be useful

Do you remember how you spent your family entertainment before the first TV series appeared on the central channels? Can you imagine a trip to work on a bicycle?and the nearest grocery at a distance of 5 km?

Technical progress raises the standard of living, but strangely enough, not its quality: most of us spend the working day in front of the monitor, rest - there, also with popcorn and French fries.

Many people prefer to forget that a fat-rich but fiber-poor fast food diet contributes to the deposition of atherosclerotic plaques.

It can be said softly: "improper diet and hypodynamia increase the risk of developing cardiovascular diseases," but in practice an unhealthy lifestyle sooner or later leads to vascular pathologies. Early diagnosis in such a situation will help to identify functional disorders before they become irreversible. Reovasography, along with ultrasound, can become a method of mass diagnostics of the population.

Principlethe action of rheography and its types

Rheography is a method of investigating blood supply to organs and parts of the human body. It is in the measurement and graphic display of pulse oscillations of the impedance , depending on the blood filling of the organ.(Impedance - tissue resistance to the passage of high-frequency alternating current.)

The idea and the first survey technology were formulated by N. Mann in 1937 and further developed by Austrian and Soviet scientists.

The field of application of rheography is practically not limited to : the brain, the ocular membrane, limbs, heart, lungs, liver and other internal organs. For procedures on separate parts of the body, there are different names:

• REG REGASTER - rheoencephalography( brain);
• ORG - ophthalmic rheography( choroid of the eye);
• RGG - rheovasography( vessels of the upper and lower extremities).

What is this - rheovasography( RVG) of the vessels of the upper and lower extremities? Consider all the nuances in order.

Indications for prescription and contraindications

Rheovasography is included in the list of regular examinations for such diseases:

1. Varicose veins, thrombophlebitis of the lower extremities, deep vein thrombosis.
2. Atherosclerosis of the lower extremities, obliterating endarteritis and other arterial lesions.
3. Rheumatic diseases( Raynaud's syndrome, systemic vasculitis, etc.)
4. Diabetes mellitus complicated by angiopathy of the vessels of the legs.

In addition, RVG provides a convenient way for to determine the nature of hemodynamic disorders of - organic or functional. The examination makes it possible to determine whether the deterioration of blood flow characteristics is due to anatomical causes or is caused by an incorrect way of life.

RVG is mandatory is prescribed based on subjective complaints of the patient on :

• convulsions or swelling of the legs;
• occurrence of vascular "stars";
• pain and / or weakness in walking, arising and disappearing for no reason;
• numbness, chilliness, blanching of feet or brushes;
• pain in the hands with a small load or at rest.

Absolute contraindications for the procedure there is no , but the relative ones are:

• exacerbation of chronic diseases;
• severe infectious diseases;
• diseases in which it is impossible to reverse antiplatelet agents, anticoagulants, hemostatics and medications that affect vascular tone - psychostimulants, analeptics, etc.

Average diagnostic cost

The price of the test varies depending on the status of the clinic, the type of rheograph and the number of samples of ( pharmacological andfunctional).

For comparison, we quote prices in other countries, popular among Russians - adherents of "medical tourism":

• Belarus - from 15 to 30 thousand barrels, but for foreign citizens there is a separate price list( on average - $ 10);
• Ukraine - from 220 to 350 UAH;
• Israel - from 100 to 200 dollars;
• Germany - from 300 to 700 euros.

Preparation rules and procedure procedure

Preparing for the RVG requires the patient following simple restrictions:

• a day before the procedure to stop taking medications that affect the fluidity of the blood and the patency of the vessels;
• at least 8 hours not to smoke, do not chew nicotine chewing gum and do not snuff tobacco;
• within 2 hours not to eat and not to be subjected to intensive physical exertion;
• 15 minutes before the procedure to take a horizontal position, relax and lie down in silence.

The temperature in the examination room is set at 20-23◦C, as the patient will have to remove anything that covers and squeezes his hands or feet, and for a while to lie motionless .

To record the impedance oscillations on both limbs of the patient, the electrodes( aluminum, lead, brass, etc.) are fixed, and they are positioned strictly symmetrically, and the skin in the attachment points is degreased with alcohol.

Depending on whether the entire limb or part of it is the subject of research, the doctor determines the location and method of applying electrodes( longitudinal or transverse).

To study the dependence of hemodynamics on external conditions, the result of RVG at rest is often compared with rheogram after various samples: pharmacological, compression or exercise tests.

For example, to exclude deep vein thrombosis, a compression test is used: briefly tighten the extremity with a cuff, and after removal repeat the RVG.To differentiate between functional and organic vascular patency disorders, a sample with nitroglycerin( 0.5 mg under the tongue, after 5 minutes - a second RVG) is used.

To compare the rheogram with the heart, in parallel, if possible, register electro- and phonocardiograms( ECG and PCG).

Main indicators: what they measure

The result of the lower and upper extremity RVG( rheogram) is a complex quasiperiodic curve, the interpretation of rheovasography is based on the study of the properties of the averaged rheographic wave:

• of quality - the presence of "peaks", steepness and steepness of "ascents" and "descents"»;
• of quantitative - amplitude value, length of some time intervals, etc.

Based on the values ​​found and the special formulas , the control indices are calculated:

• rheographic( RI, registers the intensity of arterial blood flow);
• elasticity( IE, reflects the condition of the walls of the arteries);
• peripheral resistance( IPS);
• values ​​of venous outflow( BO).

Reference intervals for indices are not given here due to the following reasons:

1. In rheography there is no uniform terminology and calculation methodology: the same coefficients, calculated under similar conditions for representatives of the same age group in different medical institutions, can differ by tens of times.
2. The norms are determined separately for each limb segment: the shoulder, forearm, hand, hip, shin, foot.
3. The values ​​of some indicators depend on age: for example, in elderly people, RI is lower than in healthy youth( especially for the lower leg vessels).

It should be noted that does not show any significant differences in the results of RVG on gender, geographic or ethnic grounds.

The way the decoding of the rheogram is described is told on the video:

The results are not normal - that further

RVG is a method though graphical, but only visualizes the results of calculations, and some characteristics of the blood flow are estimated only indirectly. Despite this, the RVG allows to exclude the vascular pathologies of with sufficient accuracy and is effective as a screening method of negative diagnostics.

But what if, during the procedure, any deviations from the norm were found?

If the rheogram records mild functional changes, the physician will prescribe an observation in the dynamics of ( repeated periodic RVG), preparations for vascular wall strengthening and physiotherapy exercises. It will be necessary to give recommendations on changing the diet and even, perhaps, the regime of work.

For more serious functional or organic disorders, shows additional examinations to diagnose and select a method of treatment: surgical or medicamentous.

Brief description of "competing" diagnostic methods

X-ray contrast( RK) or magnetic resonance( MR) angiography, ultrasonic dopplerography( UZDG) and color duplex angioscanning( DS) are also used to study the circulatory system. These methods, in contrast to RVG, allow not only to assess the tone and patency of vessels, but also to consider them in section or in three-dimensional form against the background of other anatomical structures.

RC angiography is an X-ray method, which means that it is inapplicable for examination of pregnant and young children.

Due to the severity of the procedure( anesthesia, antihistamine injection, vessel catheterization, iodine contrast and x-ray administration), the study also has additional contraindications:

• thrombophlebitis;
• is an allergy to iodine;
• cardiac or renal insufficiency.

The MR-angiography of does not carry a radiation load on the patient's body, but the MR scanner is a complex and expensive device, therefore it is still possible to examine it only in regional hospitals. The price, accordingly, will also be "regional": an order of magnitude higher than the cost of the RVG.

Duplex angioscanning is a complex variant, becausethe study occurs in parallel in two modes: conventional ultrasound( gives local two-dimensional black-and-white projections) and UZDG.By the way, there is no "triplex" scanning: it's just a marketing move using the third color "window" on the ultrasound monitor.

The surveys listed in this section are not diagnostic for the "first choice" of the ( except, perhaps, for the UZDG), but are assigned after the RVG detects deviations from the norm.

So, the basic principles of rheovasography and its differences from other methods of diagnostics of the vessels of the extremities are now known to you.

And although this is one of those surveys that anyone can "assign" to himself without harming the health and purse of the , remember that the correct interpretation of the results is only possible by the doctor who performed the diagnostics: the values ​​of the basic coefficients depend significantlyfrom the type of apparatus.