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A novel approach to bioelectrical impedance plethysmography for the assessment of arterial and venous circulatory problems in the forearm

Bejarano Monroy, M. G. (2019). A novel approach to bioelectrical impedance plethysmography for the assessment of arterial and venous circulatory problems in the forearm. (Unpublished Doctoral thesis, City, University of London)


Peripheral vascular disease (PVD) and/or peripheral arterial disease (PAD) are sicknesses known to inadequate delivery of either arterial or venous blood towards the extremities. Such sickness may trigger complications owing to the lack of transport of oxygen and nutrients, thus causing hypoxic events that may eventually prompt to ischaemic tissue or even the loss of the compromised limb. One of the most prominent indicators of prosperous health is blood volume and flow. The basic information within these health parameters may show cardiovascular problems or the advance of further complications related to other diseases like diabetes. In clinical setting, there effective methods to measure these parameters like Doppler ultrasound, photoplethysmography or venous occlusion plethysmography.
These methods take measurements from either single vessels and/or small volume of tissue. However, it is difficult to establish a relation between the obstruction of arterial and/or venous circulation and the amount of blood received by the tissue. Bioelectrical impedance plethysmography (iPG) measures blood changes by driving a small amount of AC current into the body and after measuring the potential created by fluids flowing through tissue. This technique apart from taking measures within defined volumes of tissue, it is easy to use as only needs four electrodes on the skin.
Hence, a bespoken bioelectrical impedance device including hardware and software was built ready to measure changes in blood volume/flow in the upper limbs. The system was assessed in an in-vivo controlled environment with 8 participants. The blood flow towards their left arms was altered by constricting the upper arm with a cuff at three levels: 1) below venous pressure 2) amongst venous and arterial pressure and 3) during total occlusion. Simultaneously, measurements from various instruments like ECG, Doppler ultrasound, laser Doppler flowmetry and PPG were taken and compared to the measurements obtained from the iPG instrument and defining its correlation with the impedimetric signal.
The results from the experiments showed that the bioelectrical impedance signal changed in basal and arterial pulses showing specific characteristics for each kind of occlusion. The data indicated that it is possible to differentiate between a venous and arterial occlusion by examining both components of the impedance signal. The impedance during venous occlusion dropped in average 0.658±0.230% from the baseline. On the other hand, during arterial occlusion the base impedance dropped in a higher rate approximately 1.13±04.82%, indicating a differentiator during both type of blood flow disruption. Furthermore, the impedance plethysmography waveform morphology also reshaped during these occlusive periods. The whole waveform during artificial venous obstruction increased in magnitude, the systolic peak rose 31.80%, the dicrotic notch 47.73% and the diastolic point 31.92%, where the value of the latter was higher than the dicrotic notch point. In contrast, in the time of partial arterial occlusion the waveform also increased in size at all these points, but its shape was altered. The impedance magnitude at the diastolic point went below the ones at the dicrotic notch. These fluctuations provided additional further information that it might be possible to differentiate amongst venous and arterial occlusions. By consolidating the data obtained by the iPG device, it is possible to produce an index ratio between the basal impedance and these three reference points which may help to identify early circulatory problems in the arterial and/or venous systems.

Publication Type: Thesis (Doctoral)
Subjects: Q Science
Departments: Doctoral Theses
School of Science & Technology > School of Science & Technology Doctoral Theses
[thumbnail of Mario Bejarano Monroy_PhD thesis_Redacted.pdf]
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