Comparison of the standardized Valsalva manoeuvre versus the cuff deflation method to elicit venous reflux

Abstract

Summary: Background: Two standardized methods to detect venous reflux, the Valsalva manoeuvre (VM) and the cuff deflation method (CM) are compared. Patients and methods: We included 72 patients with varicose veins (VV) and 106 patients with deep vein thrombosis (DVT). The proximal leg veins were examined. A survey was sent to the members of the Union of Vascular Societies to assess, which methods are used in the clinical practice. Results: In the VV-group the correlation coefficient (VM vs CM) for the reflux time (RT) amounted to 0.44 (p<0.0001) for the common femoral vein (CFV) and 0.4 for the femoral vein (FV) (p=0.0003). The sensitivity of the two tests in the VV group amounted to 87.5% for both methods in the CFV (p=0.4). The sensitivity for the FV amounted to 87.5% for the VM and 71.4% for the CM (p=0.4). In the DVT – group the correlation coefficient (VM vs CM) for RT amounted to 0.62 for the CFV (p<0.0001) and 0.77 for the FV (p<0.0001), as well as to 0.6 for the great saphenous vein (GSV) (p<0.0001). The sensitivity of the two tests amounted to 50.0% for the VM and 42.9% for the CM in the CFV (p=0.5). The sensitivity, if reflux was measured in the FV, amounted to 42.9% for the VM and 50.0% for the CM (p=0.5). 87.3% of the doctors who answered the survey use a non-standardized reflux measurement method. Conclusions: Both methods of reflux measurement (VM, CM) are comparable. Further studies have to address the issue, whether non standardized methods are as accurate as the standardized manoeuvres.