What is the role of the Trendelenburg test 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 Trendelenburg test can often be used to distinguish patients with superficial venous reflux from those with incompetent deep venous valves.

The leg is elevated until the congested superficial veins have all collapsed. An examining hand is used to occlude a varicose vein just below the saphenofemoral junction or at another point of suspected reflux from the deep system into the superficial varicosity. The patient stands with the occlusion still in place.

If the distal varicosity remains empty or fills very slowly, the principal entry point of high pressure into the superficial system has been identified. Rapid filling despite manual occlusion of the suspected high point of reflux means that some other reflux pathway is involved.

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