A comparison of the cuff deflation method with Valsalva's maneuver and limb compression in detecting venous valvular reflux
A. Markel, M. H. Meissner, R. A. Manzo, R. O. Bergelin and D. E. Strandness Jr
Department of Surgery, University of Washington School of Medicine, Seattle.
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.
