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Detecting Venous Reflux Using a Sixty-Degree Reverse Trendelenburg (RT-60) Position in Symptomatic Patients With Chronic Venous Disease.
J Invasive Cardiol 2016; 28(9):370-2JI

Abstract

BACKGROUND

The optimal technique to detect venous reflux requires a patient to be standing with weight on one leg while the other leg is scanned for superficial venous reflux (standing position [SP] technique). This represents a significant hardship for a subset of patients who are unable to stand and adequately maintain their balance. This study examines the predictability of identifying venous reflux using a reverse Trendelenburg 60° (RT-60) when compared with the SP in the great saphenous vein (GSV) and small saphenous vein (SSV).

METHODS

After obtaining informed consent, consecutive symptomatic patients were studied for venous reflux in the GSV and SSV using both SP and RT-60 during the same visit to the diagnostic laboratory. Reflux was analyzed in both SSV (proximal, mid, and distal segments) and GSV (proximal, mid-thigh, distal-thigh, and below-the-knee segments). Reflux was defined as duration of retrograde venous flow >0.5 seconds following rapid cuff deflation. Patients with heart failure, prior limb surgery, history of deep vein thrombosis, cellulitis, known severe pulmonary hypertension, end-stage renal disease, lymphedema, or trauma were excluded. We calculated the percentage of segments that had reflux on RT-60 out of those with reflux on SP, and the percentage of no reflux on RT-60 out of those with no reflux on SP.

RESULTS

A total of 33 patients (56 limbs, 252 segments) were included in this analysis. Mean age was 65 ± 12.4 years and 54.5% were male. All patients were symptomatic (mean clinical, etiology, anatomy, pathophysiology [CEAP] class, 3.5). Deep venous reflux was present in 3/33 patients (9.1%). Of the patients enrolled, 93.9% noted worsening swelling of their lower extremities with standing up and 53.6% of limbs were CEAP class IV or higher. All limbs with no reflux on RT-60 had no reflux using the SP and 48/49 limbs (98%) with reflux on SP also had reflux on the RT-60.

CONCLUSION

RT-60 appears to capture 98% and 100% of positive and negative reflux scans on SP, respectively, when GSV and SSV were evaluated. These findings, however, may not apply to the remainder of the venous system of the lower extremity, where SP may continue to be the standard for venous reflux evaluation.

Authors+Show Affiliations

Research Director, Midwest Cardiovascular Research Foundation, 1622 E. Lombard Street, Davenport, IA 52803 USA. shammas@mchsi.com.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27430666

Citation

Shammas, Nicolas W., et al. "Detecting Venous Reflux Using a Sixty-Degree Reverse Trendelenburg (RT-60) Position in Symptomatic Patients With Chronic Venous Disease." The Journal of Invasive Cardiology, vol. 28, no. 9, 2016, pp. 370-2.
Shammas NW, Knowles MF, Shammas WJ, et al. Detecting Venous Reflux Using a Sixty-Degree Reverse Trendelenburg (RT-60) Position in Symptomatic Patients With Chronic Venous Disease. J Invasive Cardiol. 2016;28(9):370-2.
Shammas, N. W., Knowles, M. F., Shammas, W. J., Hauber, W., Shammas, G. A., Green, M. J., & Dokas, J. (2016). Detecting Venous Reflux Using a Sixty-Degree Reverse Trendelenburg (RT-60) Position in Symptomatic Patients With Chronic Venous Disease. The Journal of Invasive Cardiology, 28(9), pp. 370-2.
Shammas NW, et al. Detecting Venous Reflux Using a Sixty-Degree Reverse Trendelenburg (RT-60) Position in Symptomatic Patients With Chronic Venous Disease. J Invasive Cardiol. 2016;28(9):370-2. PubMed PMID: 27430666.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Detecting Venous Reflux Using a Sixty-Degree Reverse Trendelenburg (RT-60) Position in Symptomatic Patients With Chronic Venous Disease. AU - Shammas,Nicolas W, AU - Knowles,Mary F, AU - Shammas,W John, AU - Hauber,William, AU - Shammas,Gail A, AU - Green,Melissa J, AU - Dokas,Julie, Y1 - 2016/07/15/ PY - 2016/7/20/entrez PY - 2016/7/20/pubmed PY - 2017/11/29/medline SP - 370 EP - 2 JF - The Journal of invasive cardiology JO - J Invasive Cardiol VL - 28 IS - 9 N2 - BACKGROUND: The optimal technique to detect venous reflux requires a patient to be standing with weight on one leg while the other leg is scanned for superficial venous reflux (standing position [SP] technique). This represents a significant hardship for a subset of patients who are unable to stand and adequately maintain their balance. This study examines the predictability of identifying venous reflux using a reverse Trendelenburg 60° (RT-60) when compared with the SP in the great saphenous vein (GSV) and small saphenous vein (SSV). METHODS: After obtaining informed consent, consecutive symptomatic patients were studied for venous reflux in the GSV and SSV using both SP and RT-60 during the same visit to the diagnostic laboratory. Reflux was analyzed in both SSV (proximal, mid, and distal segments) and GSV (proximal, mid-thigh, distal-thigh, and below-the-knee segments). Reflux was defined as duration of retrograde venous flow >0.5 seconds following rapid cuff deflation. Patients with heart failure, prior limb surgery, history of deep vein thrombosis, cellulitis, known severe pulmonary hypertension, end-stage renal disease, lymphedema, or trauma were excluded. We calculated the percentage of segments that had reflux on RT-60 out of those with reflux on SP, and the percentage of no reflux on RT-60 out of those with no reflux on SP. RESULTS: A total of 33 patients (56 limbs, 252 segments) were included in this analysis. Mean age was 65 ± 12.4 years and 54.5% were male. All patients were symptomatic (mean clinical, etiology, anatomy, pathophysiology [CEAP] class, 3.5). Deep venous reflux was present in 3/33 patients (9.1%). Of the patients enrolled, 93.9% noted worsening swelling of their lower extremities with standing up and 53.6% of limbs were CEAP class IV or higher. All limbs with no reflux on RT-60 had no reflux using the SP and 48/49 limbs (98%) with reflux on SP also had reflux on the RT-60. CONCLUSION: RT-60 appears to capture 98% and 100% of positive and negative reflux scans on SP, respectively, when GSV and SSV were evaluated. These findings, however, may not apply to the remainder of the venous system of the lower extremity, where SP may continue to be the standard for venous reflux evaluation. SN - 1557-2501 UR - https://www.unboundmedicine.com/medline/citation/27430666/Detecting_Venous_Reflux_Using_a_Sixty_Degree_Reverse_Trendelenburg__RT_60__Position_in_Symptomatic_Patients_With_Chronic_Venous_Disease_ L2 - http://www.invasivecardiology.com/articles/detecting-venous-reflux-using-sixty-degree-reverse-trendelenburg-rt-60-position-symptomatic DB - PRIME DP - Unbound Medicine ER -