Duplex ultrasonography for assessment of venous valvular function of the lower limb

Abstract

Both legs of 29 patients with venous disease and those of 15 controls without venous disease were assessed by duplex ultrasonography. The duration of reverse flow after release of manual calf compression was measured in the common femoral, long saphenous, popliteal and short saphenous veins. Before undertaking the study, the reproducibility of the technique was evaluated in six subjects by repeating the examination over 3 consecutive days; the coefficient of variation of the test was 7.3 per cent. The 95 per cent confidence interval (c.i.) of the median (0.16 s) of all measurements in the normal limbs was 0.12-0.18 s. The 95 per cent c.i. for the 95th percentile of all measurements in normal limbs was 0.32-0.52 s. In limbs with clinical evidence of venous disease at least one of the sites examined was found to have reverse flow lasting longer than 0.5 s. These data suggest that the measurement of reverse flow after release of manual calf compression is a reproducible technique. While the method records some reverse flow in normal veins, its duration is unlikely to exceed 0.5 s; significant reflux is therefore defined as reverse flow exceeding 0.5 s.

Mutations in FOXC2 Are Strongly Associated With Primary Valve Failure in Veins of the Lower Limb

“…Flow in the opposite direction (reflux) is used as a surrogate for valve failure. A small degree of reflux may occur in the presence of a functioning valve, 26 so valve failure is only considered to be present when there is Ͼ0.5 seconds of venous reflux with peak velocity Ͼ10 cm/s. 28,29 Significant reflux has been shown to occur at single sites in 32% of clinically normal humans with no evidence of venous disease.…”

“…The most common criteria for pathological reflux were used, namely, peak reflux velocity Ͼ10 cm/s and duration of reflux Ͼ0.5 seconds after release of distal compression. 25,26 Pathological reflux was only diagnosed if both of the above criteria were fulfilled. Pathological reflux was categorized, therefore, as either "present" or "absent" for each venous segment (the statistical "nominal scale").…”

Management of venous leg ulcers: Clinical practice guidelines of the Society for Vascular Surgery® and the American Venous Forum

“…[145][146][147][148] Comprehensive venous duplex ultrasound evaluates for both venous obstruction/DVT and venous reflux and includes the following components: direct visualization of deep, superficial, and perforator venous anatomic segments; compressibility; phasic venous flow with and without augmentation maneuvers; and documentation of venous reflux with measurement of valve closure time. 149,150 Venous obstruction is present when thrombosis is directly visualized, noncompressibility of vein segment is present, phasic venous flow is absent with and without augmentation maneuvers, and extensive collateral vessels are present around the segment. To identify valvular incompetence, a portion of the venous duplex ultrasound examination should be performed in the upright or standing position.…”

Experimental validation of the Paraná manoeuvre compared to the squeezing test

“…The conventional calf compression and release manoeuvre or squeezing test (ST) is generally practiced in many vascular labs and is performed by a sequence of compression and release of the calf, with several variants constituted for instance by the manual compression or instead the standardized pneumatic compression by means of a cuff [1][2][3][4] . Its execution is generally simple, one of the limitation being given by a big calf circumference, which cannot be easily compressed by a small hand.…”