What is Pulse Volume Recording?
Pulse Volume Recording (PVR) is a pneumo-plethysmography test that is widely used for non-invasive diagnosis of lower extremity peripheral arterial disease (PAD).
Pulse Volume Recording is an air plethysmography waveform analysis test used to detect the segmental volume changes in the limb resulting from the flowing blood as a function of the cardiac cycle. This test is usually performed with a PVR machine, also known as a Plethysmograph.
PVR tests are quick, reliable and painless, and can provide valuable information to help diagnose and treat PAD.
How to Perform PVR Measurements
A pulse volume recording equipment is required for this test. Perform the PVR test per the following steps:
- Make sure the patient is relaxed and in a comfortable position.
- Similar to the Segmental Blood Pressure (SBP) measurements, wrap dedicated pressure cuffs around the target limb segments prior to initiating the test. These sites typically include the thigh, above the knee, below the knee, and ankle on each leg.
- Set the PVR target pressure to a level that would occlude the venous return yet will not obstruct the arterial flow. This target pressure is typically 65 mmHg and is kept constant throughout the PVR test.
- Inflate the cuffs using a PVR machine to the selected pressure.
- Once the cuff pressure is stabilized, the Pulse Volume Recording waveform is generated based on the pressure changes in the air inside the pressure cuff as the result of minute limb circumference changes.
- Interpret the test results. The elasticity or stiffness of the arterial circulation in the legs will determine, in part, the shape of the PVR waves. This test is mostly qualitative in nature, and the focus is on the shape of the PVR-obtained waveforms.
Using the Falcon for PVR measurements
As a PVR machine, the Falcon allows immediate Pulse Volume Recording testing that can be completed very rapidly for each measured site.
PVR measurements with the Falcon vascular diagnostic system can be performed either sequentially for one site after the other, bilaterally for simultaneous PVR measurements on similar right/left leg sites, or simultaneously on as many as 10 sites in parallel.
To conduct a PVR test, the user is only required to place the color-coded pressure cuffs around each target site on both legs. Then, any PVR protocol can be selected. Now the test is ready to start and can be completed in just a couple of minutes.
All PVR settings can be pre-configured in the protocol, so only a single button can be used to complete the test. The user can modify the preferred target inflation pressure, sweep time display, scale, or filter.
Falcon users enjoy rich features and options, such as automatic simultaneous measurements or display of contralateral results. These features are designed to simplify the use of the Falcon PVR plethysmography system followed by a complete clinical diagnosis in a fast and efficient way.
While the diagnosis of Pulse Volume Recording is primarily qualitative, the Falcon also provides a range of quantitative parameters, including the waveform amplitude, rise time, or heart rate. Additional calculations such as the RAR or waveform slope are also available.
Expected Results of Pulse Volume Recording Test
The diagnosis of the Pulse Volume Recording waveforms is mostly qualitative in nature. Clinicians are normally interested in the qualitative shape of the PVR waveform, specifically the systolic rise curve, the peak amplitude shape, the dicrotic notch during the downward section, and the diastolic section of the waveform.
- Normal waveform: A normal PVR waveform has a rapid upstroke, well-defined peak, prominent dicrotic notch, and gradual downstroke. This suggests normal blood flow and vascular function.
- Reduced blood flow: If the waveform has a delayed or diminished upstroke, flattened or decreased peak, and/or rapid downstroke, it may indicate reduced blood flow due to arterial occlusion, stenosis, or poor vascular compliance.
- Severe peripheral arterial disease: A severely abnormal waveform, such as one with an absent or delayed dicrotic notch, or when the waveform amplitude decreases and ultimately becomes flat, may indicate advanced peripheral arterial disease or poor cardiac function.
Additional quantitative parameters such as the absolute PVR amplitude or the relative amplitude reduction (RAR) and slope are discussed in the literature as possible diagnostic measures.
Selected Literature
Lower Extremity PAD, Hirsch et al. 2005, ACC/AHA 2005 Guidelines for the Management of Patients With Peripheral Arterial Disease
Overview of Peripheral Arterial Disease of the Lower Extremity, Ali F. AbuRahma and John E. Campbell, Noninvasive Vascular Diagnosis, A.F. AbuRahma (ed.), Springer International Publishing AG 2017, Ch 21, pp 291-318
Objective lower extremity arterial plethysmographic waveform characteristics for differentiating significant inflow disease in nondiabetic patients, Robert Scissons, Journal of Diagnostic Medical Sonography, I6, 2014
Noninvasive Physiologic Vascular Studies: A Guide to Diagnosing Peripheral Arterial Disease, Robert Sibley et al, radiographics.rsna.org, Volume 37 Number 1, p 346-357.
2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease; A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines; Journal of the American College of Cardiology, Vol. 69, No. 11, 2017
Lower Extremity Arterial Physiologic Evaluations, Vascular Technology Professional Performance Guidelines, the Society for Vascular Ultrasound, 2019
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