A comparison of the cuff deflation method with Valsalva's maneuver and limb compression in detecting venous valvular reflux.

OBJECTIVE

This study was designed to test the results of Valsalva's maneuver and limb compression against the standing-cuff inflation-deflation method for the detection of venous valvular reflux.

DESIGN

The study was conducted in 67 patients (134 extremities) who had an episode of deep vein thrombosis. An ultrasonic duplex scanner was used to evaluate two methods of testing for reflux. The most commonly used methods are Valsalva's maneuver and limb compression, both of which can raise the venous pressure and promote reflux. With the cuff method, the patient is studied in the standing position. The cuffs are segmentally placed (thigh to foot) with reflux encouraged when the inflated cuff is suddenly deflated.

SETTING

The patients were a part of a long-term natural history study of acute deep vein thrombosis and its effects on venous valve function.

OUTCOME MEASURES

Valvular reflux was documented by the appearance of retrograde flow in the vein when the normal transvalvular pressure gradient was reversed.

RESULTS

Both limb compression and Valsalva's maneuver can elicit reflux, but the maneuvers are difficult to standardize and come up with meaningful results. With the cuff inflation-deflation method, the time to valve closure was less than 0.5 seconds in 95% of normal subjects. The results were easier to quantify and worked well for all segments of the venous systems--superficial and deep.

CONCLUSIONS

The cuff inflation-deflation method provides more uniform quantifiable results for detecting reflux in the superficial and deep veins of the leg.