Trendelenberg-Brodie Test
Purpose: To distinguish the competence of the valves of the deep venous and superficial venous system in the lower leg in patients with varicose veins possible venous insufficiency. The Trendelenberg test has high sensitivity (0.91) but low specificity (0.15) (Kim, Richards & Kent, 2000).
Procedure:
"The patient reclines on a table and the leg is elevated so that the veins are above the level of the heart. The veins promptly empty. The patient assumes the siting position and then the standing position, and it is noted whether the veins fill quickly or slowly. The same performance is now repeated, but after the veins are emptied the hand of the observer is placed over the upper end of the long saphenous vein firmly enough to prevent the passage of blood through it. The patient, with the pressure maintained, then sits up, and then stands. The pressure is maintained only momentarily, and when released, the observer notes the blood as it rushes downward through the internal saphenous system"(Mahroner and Ochsner, 1938).
An adaptation of the test is maintaining the pressure over the saphenous vein to determine if the varicosities still distend (Mahroner and Ochsner, 1938).
Instead of using the hand, a blood pressure cuff can be used at or just below the knee joint.
Normal Result: The veins fill >15 seconds with pressure released. With pressure maintained, it takes them longer than 35 seconds to refill, meaning that the deep venous system is competent.
Abnormal Result: The varicose veins fill immediately, indicating incompetency of the saphenous vein valves.
With the maintained pressure portion of the test within 35 seconds, the varicosities become distended, the deep venous valves (communicating vessels) are also incompetent.
Reference
Kim, J., Richards, S., & Kent, P. J. (2000). Clinical examination of varicose veins--a validation study. Annals of the Royal College of Surgeons of England, 82(3), 171.
Mahorner, H. R., & Ochsner, A. (1938). The modern treatment of varicose veins as indicated by the comparative tourniquet test. Annals of surgery, 107(6), 927.
Procedure:
"The patient reclines on a table and the leg is elevated so that the veins are above the level of the heart. The veins promptly empty. The patient assumes the siting position and then the standing position, and it is noted whether the veins fill quickly or slowly. The same performance is now repeated, but after the veins are emptied the hand of the observer is placed over the upper end of the long saphenous vein firmly enough to prevent the passage of blood through it. The patient, with the pressure maintained, then sits up, and then stands. The pressure is maintained only momentarily, and when released, the observer notes the blood as it rushes downward through the internal saphenous system"(Mahroner and Ochsner, 1938).
An adaptation of the test is maintaining the pressure over the saphenous vein to determine if the varicosities still distend (Mahroner and Ochsner, 1938).
Instead of using the hand, a blood pressure cuff can be used at or just below the knee joint.
Normal Result: The veins fill >15 seconds with pressure released. With pressure maintained, it takes them longer than 35 seconds to refill, meaning that the deep venous system is competent.
Abnormal Result: The varicose veins fill immediately, indicating incompetency of the saphenous vein valves.
With the maintained pressure portion of the test within 35 seconds, the varicosities become distended, the deep venous valves (communicating vessels) are also incompetent.
Reference
Kim, J., Richards, S., & Kent, P. J. (2000). Clinical examination of varicose veins--a validation study. Annals of the Royal College of Surgeons of England, 82(3), 171.
Mahorner, H. R., & Ochsner, A. (1938). The modern treatment of varicose veins as indicated by the comparative tourniquet test. Annals of surgery, 107(6), 927.
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