The Trendelenburg Test diagnostic tests for varicose veins

The Trendelenburg Test diagnostic tests for varicose veins

The Trendelenburg Test

  • This test was described by F. Trendelenburg, a German surgeon, in the last century. It is useful chiefly to demonstrate the competence of the venous valves of the superficial and communicating systems of veins. This description of it is a modification of Trendelenburg’s method. The patient first lies down on the ex­amining table. The leg to be examined is elevated to a 30 to 45 degree angle for 10 to 15 seconds to drain the blood from the superficial veins.
  • A soft rubber venous tourniquet is placed around the leg just below the knee, instead of above it, and held by hand so that the long and short saphenous veins are occluded.
  • The patient then stands erect with the tourniquet still tight, and careful obser­vation of the veins distal to the tourniquet is made. In the case of simple varicose veins, the veins will fill with blood very slowly, indicating competent valves in the deep and communicating systems. If on the other hand these veins are full of blood, almost as soon as the patient stands, it demonstrates that the valves in many of the communicating veins are incompetent and that the ones in the deep system of veins are also. If the veins fill more slowly but are full within one half to one minute, this indicates that deep veins are competent and that some, but not all, of the communicating veins are incompetent. If one suspects that the short saphenous vein is affected, the tourniquet should be placed above the knee and finger pressure exerted over the proximal end of the short saphenous vein in the distal part of the popliteal space. The patient then stands, and shortly afterward the finger pressure is released. If blood rapidly rushes down the vein on the poste­rior aspect of the lower leg, this proves that the short saphenous vein is incompetent.
  • The tourniquet has been released. Almost immediately one sees the blood cascade rapidly down from above in the large varicose veins of the lower leg. This demonstrates the incompetence of the valves in the long saphenous vein and its large varicosed tributaries. The large tortuous veins on the anterolateral aspect of the thigh are tributaries of the lateral saphenous thigh trunk which will be found to fill both proximally and distally. Since these veins will need to be excised because of their size and tortuosity, it is not essential to test them.

  • The Trendelenburg Test diagnostic tests for varicose veins

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