In my experience an individual with severe reflux doesn't need much of a slope to generate enough hydrostatic pressure to push blood backwards through a faulty valve. It just needs to have some place to go. Emptying the veins is essential to reducing the chance of a false negative.

~S

-----Original Message-----
From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Paul J Graham
Sent: Tuesday, October 23, 2012 10:27 AM
To: [log in to unmask]
Subject: Re: eliciting venous reflux

Steve

I find that to be a good analogy and a very interesting thought. I think you may have something there, in cases of severe distension maybe we should have them lie in trendelenberg for a bit and try to minimize the venous pressure and then after a few minutes try to assess the insufficiency, If nothing else it makes a provocative argument. 

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