“A good guide”

Is a mild vein weakness present? What is the venous refill time like six months after varicose vein treatment? Dr. med. Peter Kunz from the Kirchheim healthcare center (MVZ Kirchheim, Germany) uses the light reflection rheography system Bodytronic 200 to tackle many of his phlebological issues. “Quick, simple, and patient-friendly,” is his summary of the technology.

“Doctor, my legs are always so swollen in the evenings. Is it my veins?” This is the question that many patients ask when they come to Dr. Peter Kunz’s vein consultation sessions in the town of Kirchheim unter Teck in Baden-Württemberg. The specialist in surgery and vascular surgery has been working at the town’s healthcare center, which has recently been certified as a “center of expertise for veins” by the German Society of Phlebology and the German Association of Phlebologists, since 2010. “After collecting the patient’s history and performing a clinical examination, I will then often turn to light reflection rheography (LRR) as the first port of call for examination with medical apparatus. This allows me and the patient to get an initial idea of the general vein function in the legs. The measurement quickly provides a simple guide and is easy to integrate into my practical procedures,” says the specialist.

The device comes to the patient

MVZ Kirchheim has already been performing LRR measurements for a long time, and Bauerfeind’s Bodytronic 200 has been in use at the clinic for around three years now. “We really appreciate that the measurement system is so compact , and wireless too thanks to the Bluetooth connection. In contrast to our earlier apparatus, nothing gets dragged along the floor,” says Dr. Kunz. Once he has finished collecting the patient’s history and examining them, a medical assistant performs the LRR measurement. “Our Bodytronic 200 is mounted on a small trolley. This means that the device can come to where the patient is. We save a lot of time because the patient does not need to move around, or undress and dress again multiple times.” And there’s also a positive side effect: “Once I’ve finished explaining the measurement and waiting for my colleague, the patient will have already been sitting in the correct position for several minutes. The relaxed practice atmosphere is very helpful for the measurement.”
Dr. Kunz stresses that it is important for the system’s measuring sensors to be positioned correctly. “If the sensor sits right on a spider vein or perforating vein, this can result in a more dramatic reading.” If the values obtained are unusual , the sensors should therefore be repositioned and the measurement repeated.1 The vein surgeon notes that one positive factor in this examination method is that the patient is actively involved in taking the measurement.

Clearly visualized measurement result

While Dr. Kunz delegates the task of conducting the measurement itself, he reserves the duty of explaining the results. Ultimately, he says, the measurement results should always be viewed in conjunction with the patient’s reported symptoms and the clinical findings. “When explaining the values, the graphical display is of course a huge help. I can use the curve to show the patient exactly how the measurement went and explain what the values mean,” says the 46-year-old. On the one hand, this helps to put patients at ease where no abnormalities have been found – “they can see that it’s not just the physician’s subjective opinion, but is underpinned by a real measured value.” On the other hand, in patients who really do have weak veins, it encourages them to take the step of wearing compression stockings or, if indicated, to undergo varicose vein surgery.
“For patients with mild venous insufficiency or light swelling who have not yet received compression therapy, I recommend that they give the stockings a try for a few days. The patients themselves must discern what compression can do for them, and to what extent. In more severe cases, however, I am very firm and I tell them: ‘You have to wear the stocking – no discussion!’ The LRR result is one of the indicators I use to make my decision.” If Dr. Kunz believes that the findings are potentially health-threatening, he generally carries out further examination using duplex sonography. “This is usually done in a separate appointment , and the patient can experiment with the compression stocking up until that time. Depending on the sonographic findings, we then offer surgery in order to eliminate the problem at its root.”
The simple, rapid measurement that can be reproduced as many times as needed make Bodytronic 200 an attractive option for long-term assessments too, says the specialist. The software enables him to create a display of the patient’s progress across several temporally independent measurements. “This is not a routine procedure for us, but it can be interesting to measure a patient before a scheduled varicose vein operation and then measure them again after the healing stage is complete, perhaps six months or so after surgery. Of course, we hope for a much better result the second time around,” the physician adds. “And we also use Bodytronic 200 for long-term observation after deep vein thrombosis in the legs, for example. Although the LRR only measures the blood return in the superficial veins, chronic overloading of the deep venous system in the leg can have an impact on these superficial veins.”

Ideal for the physician’s office

Even though Bodytronic 200 has primarily been used by medical supply retailers up until now, the mobile, wireless system also makes it ideal for the physician’s office, Dr. Kunz believes: “It is quick and easy to use and the measurement task can be delegated. Patients react very positively to the measurement , and the system provides me with a guideline value for both legs. Here at the MVZ, we have opted for a comprehensive care-free package, and simply hire the system.”

1 The manufacturer recommends taking a repeat measurement no sooner than 30 minutes after the first one.

Images: Conny Kurz