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Karen,
 This is a common occurrence in the standing position. Muscle contraction due to instability, restlessness , anxiety, frustration. pain. or weight prevent filling of the calf & foot muscle pump. To get the patient to relax you could try placing the foot  (just the toes) on a foot stool to give the patient a sense of security,and added stability. Or you could have the patient sit on a high chair with the legs dangling  have them slide forward on the seat then lead back against the back of the chair. This will give you the window to the SFJ. You should be able to get reflex in this position even with valsalva.
 
However your patient may have normally large veins with an  incompetent of saphenous or non saphenous  branch. Were you able to visualize valve leaflets ?    
 
Carolyn M Semrow, RVS

"A master, in the art of living, draws no sharp distinction
between his work and his play, his labor and his leisure,
his mind and his body, his education and his recreation.
He hardly knows which is which. He simply pursues his
vision of excellence through whatever he is doing and leaves
others to determine if he is working or playing. To himself
he always seems to be doing both."
Francois-René Chateaubriand (1768-1848)





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From: Steven Knight <[log in to unmask]>
To: [log in to unmask]
Sent: Tuesday, October 23, 2012 6:32 AM
Subject: Re: eliciting venous reflux

Karen, do you use a rapid cuff inflator doing your studies or do you squeeze the leg manually?
~S
 
From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Karen Burns
Sent: Monday, October 22, 2012 10:28 PM
To: [log in to unmask]
Subject: eliciting venous reflux
 
I saw a patient today with very large veins, >8mm GSV( at the ankle), with multiple ropey tributaries but was not able to elicit reflux in the standing position.  She had an ulcer at the medial malleolus, hemosiderin staining in the gaitor area and edematous ankles.  The perforator at the ulcer was incompetent. I am having a very difficult time believing that this patient does not have an incompetent GSV.  Have any of you ever seen this before?  Could this patient have reflux even though I couldn't demonstrate it? 
Karen

 
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