APG® is a noninvasive diagnostic tool that quantifies the physiological components of chronic venous disease. Those components are: chronic obstruction, valvular reflux, calf muscle pump function and venous hypertension. APG® is the only system that measures true blood volume changes in milliliters and blood flow in milliliters per second.

APG® senses pressure changes in a large cuff that extends from knee to ankle, which is calibrated in milliliters using a calibration syringe.

The test protocol for APG® has three phases. First, the patient is supine and outflow testing identifies obstruction and the degree of superficial collateralization. Next, the patient is asked to stand and the filling rate of the veins by reflux through incompetent valves is measured. The patient is then asked to do a toe-up exercise and the calf muscle pump function is measured as an ejection fraction. Finally, the patient does 10 toe-ups quickly and a noninvasive measure of ambulatory venous pressure is completed.

The presence of chronic obstruction usually indicates a post-thrombotic limb. If the saphenous system is measured to be the limb's primary outflow collateral by APG®, its removal may become problematic for the patient. Reflux in the deep and superficial veins are separately quantified to allow the physician to understand how the two systems contribute to the patient's symptoms. Poor calf muscle pump function may be due to obstruction, varicose veins calf perforator reflux or the patient's inability to perform exercise from arthritis, stroke, etc. APG® is now used in studies to identify patients for the new subfacial endoscopic perforator surgery (SEPS). Both reflux and poor calf pump function are related to clinical manifestations of the disease.

APG® helps identify and follow-up patients that are good candidates for deep venous reconstruction. Also, as testing can be performed over compression garments, the effectiveness of elastic or non-elastic compression devices can be assessed and tailored to the individual patient. Other uses for APG® include its use in selecting the best arm for dialysis access graft or AV fistula. Arterial inflow can be measured to identify patients that are the best candidates for drug therapy (such as synthetic prostacyclin) and for follow-up to vascular interventions.

A modified version of the APG® system has been used on the Mir Space Station to quantify the effects of prolonged microgravity on peripheral vascular tone in arms and legs.

  • For more clinical and technical information on APG® usage,
    click here for the ADVANCED COURSE
  • For more information regarding venous disorders, try the veincenter website.

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    ArtAssist®, VenAssist®, VenaPulse®, and APG® are register trademarks of ACI Medical, LLC, San Marcos, CA, USA.