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I'm not sure I can go along with your analysis but I'm going to think on it some more before I comment.
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."
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We discussed this at our chapter meeting on Saturday and I had a similar circumstance today with a patient with DVT. I didn’t want to use auto inflator. In cases of gross insufficiency the veins become maximally dilated with little or no capacitance for regurgitant flow. You cannot put more water into a bucket that is already full to the brim. Ergo you will have trouble showing reverse flow.
I’m not saying that is what happened in your case but if you suspect that in the future you might try DECREASING hydrostatic pressure (have patient lay in moderate footdownberg) so that you can squeeze enough volume out of the veins to allow
space for them to refill with retrograde flow.
Eager for others to chime in on this.
From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Karen
Sent: Tuesday, October 23, 2012 9:40 AM
To: [log in to unmask]
Subject: Re: eliciting venous reflux
We normally use a rapid cuff inflator, but didn't on this case. Do you think that makes a big difference?
Sent from my iPhone
Karen, do you use a
rapid cuff inflator doing your studies or do you squeeze the leg manually?
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?
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