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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. To unsubscribe or search other topics on UVM Flownet link to: http://list.uvm.edu/archives/uvmflownet.html