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Reverse Trendelenburg (RT) duplex ultrasound (DUS) shows good agreement with standing position (SP) DUS for chronic venous insufficiency (CVI). RT DUS detects more venous reflux at the saphenofemoral junction and may be a reliable initial diagnostic tool.

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Area of Science:

  • Vascular Medicine
  • Diagnostic Imaging
  • Ultrasound Technology

Background:

  • Chronic venous insufficiency (CVI) is a prevalent vascular condition with varied severity.
  • Venous reflux is the primary cause of CVI, typically assessed via duplex ultrasound (DUS) in the standing position (SP).
  • Some patients cannot tolerate SP assessment, necessitating alternative methods like the reverse Trendelenburg (RT) position.

Purpose of the Study:

  • To compare the efficacy of DUS in detecting venous reflux in the RT versus SP positions for patients with CVI.
  • To evaluate the agreement and differences in reflux detection between RT and SP DUS assessments.

Main Methods:

  • A cross-sectional study involving 105 CVI patients, classified by the revised CEAP system.
  • DUS measurements of vein diameter and reflux duration at key venous junctions (SFJ, SPJ) and segments (GSV, SSV) in both RT and SP.
  • Statistical analysis using Cohen's kappa for agreement and McNemar's test for paired differences.

Main Results:

  • High overall agreement between RT and SP DUS across venous segments (78-95% concordance).
  • Significantly more reflux detected in RT compared to SP at the saphenofemoral junction (p < 0.001).
  • Mean vein diameters were smaller in RT, suggesting potential for improved reflux visualization.

Conclusions:

  • RT DUS is a reliable method with good agreement to SP DUS for CVI assessment.
  • RT DUS demonstrates increased sensitivity for detecting reflux at the SFJ.
  • RT positioning can serve as a valuable initial diagnostic approach, potentially enhanced by combining with SP assessments.