Doppler ultrasound diagnosis of lower extremity deep vein insufficiency: Valsalva maneuver or pneumatic cuff?
To compare the efficacy of Valsalva maneuver and pneumatic compression techniques in detecting lower extremity deep venous and saphenofemoral insufficiency.
MATERIALS AND METHODS:
Eighty-one extremities evaluated in 43 patients who had undergone Doppler ultrasound examination of the lower extremity venous system were included in the study. Valsalva maneuver and pneumatic cuff techniques were used to elicit reflux in the standing position. Reflux was investigated with spectral Doppler in the superficial femoral vein, popliteal vein, the proximal segment of the great saphenous vein close to its junction with the femoral vein and in its caudal segment at the medial aspect of the knee. The same measurements were repeated after rapid deflation of the pneumatic cuff, which was applied to the calf and was initially inflated to 200 mmHg. Retrograde flow exceeding 1000 msec was regarded as insufficiency. The results of the two techniques at each venous segment were compared with the McNemar test.
Deep venous and/or saphenofemoral insufficiency were detected in 61 of the 81 extremities. The cuff deflation technique was superior at the popliteal vein and caudal segment of the great saphenous vein. The Valsalva maneuver was superior at the superficial femoral vein. The statistical results did not change when the McNemar test was repeated for reflux exceeding 2000 msec.
Combined application of Valsalva maneuver and pneumatic cuff techniques will lead to more accurate evaluation and increased detection of lower extremity venous insufficiency.