Lower Extremity Venous Reflux Study

1. 1

   Patient standing or in reverse Trendelenburg. Supine gives false negatives — this step is mandatory.

2. 2

   SFJ: probe at groin, GSV origin. Apply distal cuff augmentation then release — time any retrograde flow. >0.5s = pathologic reflux.

3. 3

   GSV thigh: follow GSV distally, augmenting and releasing at each level. Mark refluxing segments.

4. 4

   GSV below knee: continue to ankle if reflux present. Measure GSV diameter in standing.

5. 5

   SPJ/SSV: probe popliteal fossa. Identify SSV entering popliteal vein. Augment calf and release — assess for reflux.

6. 6

   Perforating veins: thick-walled veins connecting superficial to deep. Bidirectional flow >0.35s = incompetent.

7. 7

   Deep system: assess CFV, FV, and popliteal for reflux (>1.0s in deep veins is pathologic). Mark all incompetent segments for ablation planning.

• SFJ — reflux with Valsalva/cuff release
• GSV thigh — reflux assessment
• GSV below knee — reflux
• SSV at SPJ — reflux with calf compression
• Deep system — CFV, FV, popliteal vein reflux
• Perforating veins — bidirectional flow

• Reflux duration at SFJ and GSV (>0.5s = pathologic)
• Perforating vein reflux (>0.35s bidirectional flow)
• GSV diameter in standing position
• SPJ competence
• Deep vein reflux

• Study must be performed in standing or reverse Trendelenburg position — supine gives false negatives
• Reflux >0.5s in superficial veins is pathologic; >1s in deep veins is pathologic
• Augmentation should be distal-to-proximal (cuff inflation then release)

Perform in standing position. Augment distally and release to provoke reflux. Mark GSV with skin marker for ablation planning.