What is the role of the Perthes maneuver in the physical exam of varicose veins and spider veins (telangiectasia)?

Updated: Sep 25, 2020
  • Author: Robert Weiss, MD; Chief Editor: William D James, MD  more...
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The Perthes maneuver is a traditional technique intended to distinguish antegrade flow from retrograde flow in superficial varices. Antegrade flow in a variceal system indicates that the system is a bypass pathway around deep venous obstruction. This is critically important because, if deep veins are not patent, superficial varices are an important pathway for venous return and must not be sclerosed or surgically removed.

To perform the Perthes maneuver, a Penrose tourniquet is placed over the proximal part of the varicose leg in such a way as to compress superficial varicose veins but not the deep veins. The patient walks or performs toe-stands to activate the calf muscle pump. The calf muscle pump normally causes varicose veins to be emptied, but if deep system obstruction exists, then the varicose veins paradoxically become more congested.

If the result of the Perthes maneuver is positive (ie, distal varices have become engorged), then the patient is placed supine with the tourniquet in place and the leg elevated (Linton test). If varices distal to the tourniquet do not drain after a few seconds, deep venous obstruction must be suspected. These maneuvers are not consistently reliable and are of primarily historical interest.

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