Standing versus Supine Evaluation for Superficial Venous Reflux

Abstract

Objective

—The established belief in the absolute need to perform duplex ultrasound evaluations for venous insufficiency in the standing position continues to be, in our view, an unsettled issue. To our knowledge the circumstances when a supine examination is both accurate and advantageous have not been prospectively evaluated or definitively resolved. The primary purpose of this study was to address this problem.

Methods

—To address this issue, 645 lower-limb venous segments were examined in 72 consecutive patients, first supine and subsequently in the standing position. Valsalva maneuver and manual compressions were used as provocative maneuvers. Measurements of reflux duration were recorded. Reflux was considered positive if the measurement was ≥0.5 sec. The length of the examination as well as the degree of patient and examiner ease and comfort also were noted.

Results

—We observed that when reflux at the saphenofemoral junction in the initial supine examination was ≥1.13 sec in duration, reflux ≥0.5 sec was always present during the standing examination (p < 0.001). We also noted that reflux duration at all levels was consistently greater in the supine position with a tendency for such differences to increase distally.

Conclusion

—Testing in the standing position only needs to be performed if the initial supine evaluation demonstrates reflux <1.13 sec in duration.