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Surgeon General Reports, SAMHSA TIPs, SAMHSA PEPs  AHCPR Archived Technology AssessmentsPlethysmography: Safety, Effectiveness, and Clinical Utility in Diagnosing Vascular Disease Prepared by: Ann A. Graham, MPH, CRNA Health Technology Assessment: Number 7 U.S. Department of Health and Human Services Public Health Service Agency for Health Care Policy and Research Rockville, Maryland February 1996 AHCPR Pub. No. 96-0003 View the Medline Citation and Related Citations using PubMed AbstractPlethysmography, a semiquantitative method of measuring segmental blood flow and velocity in the carotid and peripheral vascular systems, is safe, easy to perform, and inexpensive.
Impedance, strain guage, air, and photoelectric plethysmographic methods are assessed in this publication for their relative safety, efficacy, and clinical utility in diagnosing vascular disease.
Clinical evidence has demonstrated, for example, that oculoplethysmography is not a reliable screening test for carotid artery disease, particularly in bilateral disease and nonocclusive unilateral disease.
Oculoplethysmography is thus no longer recommended for the diagnosis of carotid artery disease.
Impedance, strain guage, and photoplethysmography methods can be used for the initial evaluation of acute and chronic venous insufficiency, although there is great variability in the reliability of these tests to predict venous disease in the presence of nonobstructive thrombi and comorbid conditions.
Strain guage and photoelectric plethysmography can be safely used for the evaluation of peripheral arterial disease.
but surgical candidates for arterial reconstruction and some venous disorders may require additional imaging such as duplex ultrasound, venography, or arteriography for anatomic information that is not elucidated by plethysmography.
The plethysmographic techniques reviewed in this assessment, evaluating the ability to predict the presence of flow reduction in the carotid and peripheral circulations, are based on the technical performance of the tests as compared with a reference method.
Establishing evidence-based conclusions proved difficult in light of biases such as nonrandomization, unstated patient selection criteria, poor followup of patients, and lack of blindness in some studies. The Center for Health Care Technology (CHCT) evaluates the risks, benefits, and clinical effectiveness of new or unestablished medical technologies. In most instances, assessments address technologies that are being reviewed for purposes of coverage by federally funded health programs. CHCT's assessment process includes a comprehensive review of the medical literature and emphasizes broad and open participation from within and outside the Federal Government. A range of expert advice is obtained by widely publicizing the plans for conducting the assessment through publication of an announcement in the Federal Register and solicitation of input from Federal agencies, medical specialty societies, insurers, and manufacturers. The involvement of these experts helps ensure inclusion of the experienced and varying viewpoints needed to round out the data derived from individual scientific studies in the medical literature. CHCT analyzed and synthesized data and information received from experts and the scientific literature. The results are reported in this assessment. Each assessment represents a detailed analysis of the risks, clinical effectiveness, and uses of new or unestablished medical technologies. If an assessment has been prepared to form the basis for a coverage decision by a federally financed health care program, it serves as the Public Health Service's recommendation to that program and is disseminated widely. CHCT is one component of the Agency for Health Care Policy and Research (AHCPR), Public Health Service, Department of Health and Human Services.
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