Functional tests for varicose veins. Conduct a study of the Delbe-Perthes marching test and the Troyanov-Trendelenburg test. Delbe-Perthes marching test

Determining the patency and functional state of the deep veins is strictly mandatory not only when deciding on surgical treatment, but also in all cases of medical and labor examination and the appointment of treatment and preventive recommendations. The condition of the deep veins of the lower extremities can be assessed based on the following tests:

The Delbe-Perthes test (marching test) is performed with the patient in an upright position. A rubber tourniquet or cuff from a device for measuring blood pressure is applied to the limb being examined in the middle third of the thigh, with figures not exceeding 60-80 mm Hg. The patient is asked to walk quickly or march in place for 5-10 minutes. If the tension of the saphenous veins decreases or they collapse completely, the deep veins are passable, the test is considered positive. If pain appears in the calf muscles and the saphenous veins do not empty, one should think about a violation of the anatomical usefulness of the deep veins. In these cases, it is advisable to use radiopaque venography. The Delbe-Perthes test is the most common, as it provides the most reliable information about the condition of the deep veins. The march test may not always be indicative in case of functional valvular insufficiency of the deep and communicating veins, occlusion of perforating veins, which is quite rare, as well as in obese people with pronounced subcutaneous fat and in inductive changes in soft tissues. In these cases, they resort to modifications of the Delbe-Perthes test: Mahorner and Ochsner test, Chervyakov test.
The Mahorner-Ochsner test involves walking with tourniquets applied at different levels: in the upper, middle and lower third of the thigh. If the deep veins are passable and the communicating veins are healthy, then there is a decrease in tension, and sometimes a complete disappearance of varicose veins.
The Chervyakov test is performed in those patients who do not have visible varicose veins. The calf circumference is measured at a certain level when it is raised (1st measurement), in a lowered position (2nd measurement) and after a 3-minute walk with a tourniquet (3rd measurement). The coincidence of 1 and 3 measurements indicates the patency of the deep veins.
Ivanov's test. The patient is in a horizontal position. The limb being examined is slowly raised upward until the superficial veins are completely emptied. The angle formed by the raised limb and the plane of the couch is determined (the “compensation angle”), then the patient stands up and, after tightly filling the varicose dilated superficial veins, a rubber tourniquet is applied to the middle third of the thigh. The patient lies down on the couch again, the limb is quickly raised to the previously determined “compensation angle”, and the emptying of the veins is observed. If the veins quickly collapse, this indicates good patency of the deep veins. If the latter are obstructed, emptying of the superficial veins does not occur.
Strelnikov's test ("cuff" method). A sphygmomanometer cuff is placed on the patient in an upright position on the thigh or lower leg (depending on the purpose of the study), the pressure in which is adjusted to 35-40 mm Hg. At the same time, the superficial veins swell. Then the patient is transferred to a horizontal position and if emptying of the superficial veins occurs, this indicates that the deep veins are passable. The last two tests differ from the Delbe-Perthes test in that they do not reflect the state of the perforating vein valves and the function of the deep vein valves.
Mayo-Pratt test. The patient, who is in a horizontal position, is tightly bandaged with an elastic bandage from the fingers to the upper third of the thigh (or put on a rubber stocking). Then they suggest walking for 20-30 minutes. The absence of unpleasant subjective sensations indicates good patency of the deep veins. If, after a long walk, severe bursting pain appears in the lower leg area, then the patency of the deep venous system is impaired. The Mayo-Pratt test is based on the subjective sensations of the patient, so its result cannot be considered reliable.
Lobelin test of Firth and Heichal. A limb with varicose veins is bandaged with an elastic bandage, eliminating the possibility of superficial blood circulation. Lobelia is injected into one of the veins of the foot (1 mg per 10 kg of weight). If within 45 sec. If a cough does not appear, the patient must take a few steps in place and again wait 45 seconds. If a cough does not appear, we can assume that the deep veins are obstructed. This is confirmed by the appearance of a cough after removing the elastic bandage in a horizontal position.

The principle of other medicinal methods is no different from lobeline. These methods are simple, but they are all very subjective, not accurate enough and very often cause side effects.

If the data from the performed functional tests turn out to be questionable or insufficiently reliable, and also indicate obstruction of the deep veins, it is necessary to resort to more objective, instrumental methods of examination. These include ultrasound Dopplerography, oscillography, plethysmography, capillaroscopy, rheovasography, skin thermometry, radioindication, electromyography, phlebotonometry, etc. X-ray contrast methods are carried out at the final stage of a comprehensive examination, when all other functional and instrumental methods fail to establish the patency of the deep veins and the condition valve apparatus.

M.Averyanov, S.Izmailov, G.Izmailov, M.Kydykin, Yu.Averyanov

Chronic diseases of the veins of the lower extremities,

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Inspection and functional tests

Diagnosis of primary varicose veins of the saphenous veins in most cases is not difficult. The examination should begin with anamnesis. Examination of the lower extremities is carried out with the patient in an upright position. Palpation of the veins makes it possible to establish the extent of the lesion, the nature and degree of expansion of the saphenous veins, the presence of trophic disorders, the difference in the volume of the limbs and skin temperature.

For each patient it is necessary to determine:

1. Localization and extent of the lesion.

2. The functional ability of the valve apparatus in the system of the great and small saphenous veins.

3. Condition of the communicating veins.

4. The nature (primary or secondary) and severity of varicose veins.

5. Functionality of the deep veins of the lower extremities.

6. Degree of severity of trophic disorders.

7. Assess the general condition of the patient, the possibility and extent of the operation, and the method of pain relief.

The functional state of the valvular apparatus of the veins is determined using various functional tests. The most widely used in clinical practice are the Brodie-Troyanov-Trendelenburg, Hackenbruch-Sicart, Pratt, and Delbe-Perthes tests. They are easy to perform and the most informative compared to other functional tests.

The Brodie-Troyanov-Trendelenburg test determines the condition of the ostial valves, the valve apparatus of the saphenous and communicating veins. The patient is laid horizontally, the leg is raised until the veins are completely empty. A tourniquet is applied just below the inguinal fold, squeezing the saphenous veins, then the patient is transferred to a vertical position and the nature of the filling of the veins is monitored. There are four criteria in the evaluation of this sample: positive, negative, double positive and zero sample result. Slow filling of the veins when a tourniquet is applied and rapid filling from top to bottom after removing the tourniquet indicates functional insufficiency of the valves of the great saphenous vein and, above all, the ostial valve. This is a positive test result. The test is considered negative if, with a tourniquet applied in a vertical position of the patient, the vein quickly (10-12 s) fills with blood from bottom to top, and removal of the tourniquet does not increase its filling. This is evidence of the failure of the valve apparatus of the communicating veins with satisfactory function of the valves of the great saphenous vein. A double positive test result will occur when the saphenous veins fill quickly before the tourniquet is removed, and after its removal, the tension of the veins increases, which is due to insufficiency of the saphenous and communicating vein valves. If the test result is zero, the veins slowly fill from bottom to top when the tourniquet is applied, and removing it does not cause tension in the veins. This picture is observed when the valve apparatus of the saphenous and communicating veins is preserved.

To determine the functional state of the valves of the small saphenous vein, a tourniquet should be applied to the upper third of the leg. Evaluation of the test results is carried out according to the same principle.

The consistency of the valve apparatus of the deep and saphenous veins can be determined using the Hachenbrach-Sicard “cough push” test. When the patient coughs (in the vertical position of the patient - the Hackenbruch test, in the horizontal position - the Si-kara test), a push is noted in the projection of the vein by palpation or upon examination due to the transmission of increased pressure in the distal direction of the vein.

The functional state of the communicating veins is also determined by Pratt's double-band test (G.H. Pratt, 1941). It is done as follows. After the saphenous veins are emptied, with the patient in a horizontal position, a venous tourniquet is applied below the inguinal fold and the leg is bandaged with an elastic bandage from the toes to the tourniquet. Then the patient is transferred to a vertical position. The bandage is slowly removed from top to bottom. As the limb is freed from the bandage, a counter elastic bandage is applied, compressing the saphenous veins. The distance between the bandages should be 5-7 cm. In this area of the limb, communicating veins are marked, the location of which is recognized by a bulging venous node or trunk. The study is carried out throughout the entire limb.

The consistency of the deep veins and their patency are revealed by the Delbe-Perthes marching test (Delbet-Perthes, 1897). With the patient standing, a tourniquet is applied to the upper third of the thigh or upper third of the leg, compressing the saphenous veins. The patient then walks or marches in place. Normally, the dilated veins empty within one minute. Bursting pain in the leg and increased tension in the saphenous veins (negative test) indicate a violation of the patency of the deep and functional failure of the valves of the communicating veins.

Fegan's test (W.G. Fegan, 1967) - with the patient in a vertical position, dilated veins are noted, and then in a horizontal position in these areas, defects in the fascia are palpated and pressed with fingers, then the patient is transferred to a vertical position, fingers alternately release the pressed holes in fascia. The appearance of signs of retrograde blood flow indicates the presence of an incompetent communicating vein in this place.

Carrying out the listed functional tests is mandatory when examining patients with varicose veins of the lower extremities.

Phlebography

Functional tests do not always provide a sufficiently clear picture of the state of the deep venous system of the limb and do not allow deciding the possibility of surgical treatment. In such cases, venography is indicated.

X-ray contrast venography for varicose veins of the lower extremities in our country was first used in 1924 by S.A. Reinberg, who proposed injecting a 20% solution of strontium bromide into varicose nodes. V. Drachar (1946) was the first to perform venography of the lower extremities by injecting uroselectate into the medial malleolus. Subsequently, intraosseous venography was improved by V.N. Shanis (1950-1954) and R.P. Askerkhanov (1951-1971), but this method was not widely used due to the frequent development of osteomyelitis and other complications.

Currently, there are many techniques for performing phlebography. In most cases, the contrast agent is administered intravenously. However, it should be remembered that the radiocontrast method is not always safe for the patient, and for varicose veins it has its own strict indications. It should be used when all known clinical tests and non-invasive research methods do not allow the diagnosis to be clarified.

Phlebography is of particular importance in case of postoperative relapses of varicose veins of the saphenous veins. A number of authors (I.I. Zatevakhin et al., 1983; L.V. Poluektov, Yu.T. Tsukanov, 1983; R.I. Enukashvili, 1984; M.P. Vilyansky et al. , 1985) considers it obligatory to carry out a phlebographic examination in case of relapses of varicose veins. G.D. Konstantinova et al. (1989) indicate that venography has improved the diagnosis of various forms of lesions of the veins of the lower extremities by 80%. According to K.G. Abalmasova et al. (1996), in case of relapse of varicose veins and various types of valvular insufficiency of the veins, the venographic method has almost 100% information content.

We believe that in case of relapses of the disease, venography is indicated in cases where examination of the patient and functional research methods do not clearly establish the cause of the relapse and when it is necessary to resolve the issue of correction of valvular insufficiency of the deep veins. Methods of phlebographic studies and measures to prevent possible thrombotic complications were described in detail in the chapter “Post-thrombotic disease”. Intravenous functional-dynamic phlebography, as mentioned above, is the most informative. In the absence of appropriate equipment, distal ascending venography can be used with the patient in a horizontal position. The contrast agent is injected through the saphenous veins of the dorsum of the foot or through the deep veins located behind the medial malleolus. The amount of injected radiopaque substance is taken at the rate of 1 ml per 1 kg of the patient’s body weight. Usually, to obtain a clear image of the venous system of one limb with a single injection, 40.0-50.0 ml of a 50% solution of a contrast agent is sufficient. When performing vertical retrograde femoral venography, the amount of contrast agent can be reduced to 10.0-20.0 ml. Prevention of thrombotic complications after the study is mandatory.

The main angiographic symptom of varicose veins (Yu.T. Tsukanov, 1979-1992) is limited or widespread dilation of the lumen of the veins in the absence of signs of their destruction. The internal contours of the vessels are smooth, clear, there are no stenoses or occlusions. The disease is characterized by a multiplicity of dilations, involving a significant part or all of the venous system of the limb. A criterion for the degree of expansion of the deep veins of the leg can be a comparison of their diameter with the width of the fibula, the excess of which indicates significant ectasia of the veins.

According to G.D. Konstantinova et al. (1976 and 1989), characteristic angiographic signs of varicose veins are poor contrast of the valves of the main veins and a decrease in their number. Long-term contrast of deep main veins and slow evacuation of the contrast agent, detected during phleboscopy, can also be pathognomonic for varicose veins. These processes are based on a violation of the evacuation ability of ectatic deep veins and a decrease in the function of the muscle pump of the lower leg. X-ray signs of damage to the iliac veins are their elongation, tortuosity, S-shaped deformation (L.V. Poluektov, Yu.T. Tsukanov, 1983). The symptom of horizontal reflux, which is observed in the stage of sub- and decompensation of the disease, is caused by the incompetence of the communicating veins. Insufficiency of the valve apparatus of the deep veins is most clearly revealed in the form of a symptom of vertical reflux (R.P. Zelenin, 1971; E.P. Dumpe et al., 1974; etc.). Retrograde vertical phlebography makes it possible to judge not only the degree of pathological reflux, but also the condition of the valve leaflets. If their contours are traced, relative valve insufficiency occurs. If the contours of the valve sinuses cannot be detected, then anatomical inferiority of the valves is more likely, which indicates the impossibility of their complete extravasal correction.

Ultrasound methods

Ultrasound research methods, as mentioned above, are of great importance in phlebological practice. In case of varicose veins, to determine the viability of the remaining valves, the condition of the valve apparatus of the saphenous and communicating veins, to identify the patency of the deep main veins and to assess the effectiveness of the surgical correction performed, they are the main ones and can completely replace an X-ray contrast study. The capabilities of ultrasound methods were described in the chapter “Post-thrombotic disease”, so there is no need to dwell on this issue in more detail here.

Other research methods (rheovasography, lymphography, phlebotonometry, etc.) in the diagnosis of varicose veins are of auxiliary value and are performed for appropriate indications.

Differential diagnosis

In most cases, recognizing primary varicose veins of the lower extremities does not present much difficulty. Diseases that clinically resemble varicose veins should be excluded. First of all, it is necessary to exclude secondary varicose veins due to hypoplasia and aplasia of the deep veins (Klippel-Trenaunay syndrome) or previous deep vein thrombosis, the presence of arteriovenous fistulas in Parkes Weber-Rubashov disease (P.F. Weber, 1907; SM. Rubashov, 1928 .).

Postthrombotic disease is characterized by an increase in the volume of the limb due to diffuse edema; the skin of the limb has a cyanotic tint, especially in the distal parts; dilated saphenous veins have a scattered appearance, and their pattern is more pronounced on the thigh, in the groin area and on the anterior abdominal wall.

Klippel-Trenaunay syndrome (M. Klippel, P. Trenaunay, 1900), caused by aplasia or hypoplasia of the deep veins, is very rare, appears in early childhood, and gradually progresses with the development of severe trophic disorders. Varicose veins have an atypical localization on the outer surface of the limb. There are pigment spots on the skin in the form of a “geographical map”, hyperhidrosis is pronounced.

Parkes Weber-Rubashov disease is characterized by lengthening and thickening of the limb, atypical localization of varicose veins; veins often pulsate due to the discharge of arterial blood; hyperhidrosis, hypertrichosis, the presence of pigment spots like a “geographic map” are noted over the entire surface of the limb, often along the outer surface of the pelvis, on the abdomen and back, hyperthermia of the skin, especially over dilated veins, arterialization of venous blood. The disease manifests itself in early childhood.

Pratt (G.H. Pratt, 1949), Piulachs and Vidal-Barraquer (P. Piulachs, F. Vidal-Barraquer, 1953) distinguish “arterial varicose veins,” in which varicose veins are a consequence of the functioning of multiple small arteriovenous fistulas . These fistulas are congenital in nature and open during puberty, pregnancy, after injury or excessive physical stress. Dilated veins are localized most often along the outer or posterior surface of the leg or in the popliteal fossa. The valve apparatus of the saphenous main veins in this form of varicose veins can be wealthy. After surgery, varicose veins quickly recur, and, as a rule, radical treatment of this form of varicose veins is impossible.

Aneurysmal dilatation of the great saphenous vein at the mouth must be differentiated from a femoral hernia. The venous node above the Pupart ligament disappears when the leg is raised, and sometimes a vascular murmur is heard above it, which is not observed with a femoral hernia. The presence of varicose veins on the affected side often speaks in favor of a venous node.

Selected lectures on angiology. E.P. Kokhan, I.K. Zavarina

To establish the prevalence and nature, special functional tests for varicose veins of the lower limb: according to Troyanov-Trendelenburg, Delbe-Perthes, as well as three- and multi-strand tests according to Sheinis et al.

Troyanov-Trendelenburg test

After the superficial vein is emptied with the patient in a horizontal position, the large saphenous vein in the area of the mouth is pressed with a finger or compressed by applying a tourniquet at the base of the thigh and the patient is quickly transferred to a standing position. Stop squeezing the vein. If the dilated vein quickly fills with blood, the test is considered positive and indicates insufficiency of the ostial (remaining) valve. If the vein fills slowly, the test is considered negative.

Three-strand test

To more accurately determine the condition of the valves of the communicating (perforating) veins, a three-strand test is performed. Two tourniquets are applied to the thigh area and one to the lower leg. Rapid filling of the veins in the area between the tourniquets when the patient is in an upright position indicates insufficiency of the valves of the perforating veins in this segment.

Marching test according to Delbe-Perthes

The condition of the valves of the deep and communicating veins is determined using the Delbe-Perthes march test. The patient in an upright position (in a state of filling the veins) has a venous tourniquet applied to the area of the upper or middle third of the thigh and is asked to walk for 5 minutes. With sufficient function of the valves of the deep and communicating veins, the superficial veins are emptied after walking, and if they are incompetent or the deep veins are obstructed, the superficial veins remain filled. To judge the level of damage, 5 tourniquets are applied - 2 on the thigh and 3 on the lower leg. The release of veins even in one space indicates the preservation of the valves at this level.

The advent of ultrasound duplex scanning has virtually completely replaced the performance of functional tests when varicose veins are suspected. The step test, three-strand test, cough test and Valsava test do not require complex equipment and are performed by a surgeon as part of a physical examination.

The essence of functional tests is to assess normal hemodynamics, which allows us to draw a conclusion about the location and source of the problem. Incompetent perforating veins lead to increased hydrodynamic pressure. Typically, emptying of the deep veins occurs under the action of the muscle pump of the lower leg. If the perforator valves are incompetent, the pressure created in the deep venous system is transferred to the superficial veins. All functional tests study the reaction of the venous system to load:

the initial state is assessed visually;
is compared with the result obtained after the test.

The data obtained allows you to quickly make a diagnosis and check the effectiveness of treatment.

Veins of the leg

Tests used for varicose veins divided into three categories, depending on the component of the venous system being tested:

Heckenbruch-Sicard, Trendelenburg, Schwartz tests - determine the condition of surface pipeline valves.
The Hackenbruch, Thalmann tests, the second from Pratt and the tourniquet test from Sheinis - evaluate the consistency of the perforating veins.
Mayo-Pratt, Delbe-Perthes test - aimed at deep veins.

Each test, e.g. marching test, evaluates the reaction of superficial veins to various situations - compression, compression, physical activity.

Valsalva maneuver

The Valsalva maneuver is a special breathing technique that is used to diagnose disorders in the autonomic nervous system and restore normal heart rhythm. The technique is named by the 17th century Italian physician Antonia Maria Valsalva. You are supposed to exhale when your airway is blocked. A simplified version of the maneuver is used to balance pressure in the ears to relieve congestion.

Hemodynamics of the Valsalva maneuver

During forced exhalation with the glottis closed, intrathoracic pressure changes, affecting venous return, cardiac output, blood pressure and heart rate.

During the first phase of the Valsalva maneuver, intrathoracic (intrapleural) pressure becomes positive due to the compression of the thoracic organs when the chest is compressed. External compression of the heart, blood vessels and cardiac chambers increases, reducing transmural pressure on the walls. Venous compression is accompanied by an increase in right atrial pressure, which prevents venous return to the chest.

A decrease in venous return when the chambers of the heart are compressed reduces the preload against the background of significant pressure inside the chamber. According to the Frank-Starling law, cardiac output decreases. The aorta contracts and the pressure in the vessel increases. But in the second phase of the test, the aortic is reset due to a drop in cardiac output. Under the influence of baroreceptors, the heart rate changes: in the first phase it decreases due to an increase in pressure in the aorta, and in the second it increases.

When breathing is restored, aortic pressure decreases briefly as the force of external pressure disappears. The heart reflexively begins to beat faster - this is phase three. The pressure in the aorta increases, cardiac output increases and the pulse rate slows down again - phase four. Aortic pressure increases due to effects on baroreceptors due to increased vascular resistance.

Such changes always occur when a person tries to exhale with contracted abdominal muscles or reflexively holds his breath, strains when going to the toilet and lifts weights.

Using the test for varicose veins

The Valsava test is used in clinical medicine to assess venous return in varicoceles, abdominal hernias, and deep vein thrombosis. The test is used in addition to CT and MRI examinations.

With varicose veins, it is necessary to increase intrathoracic pressure in order to block the outflow of venous blood from the lower part of the body from the inferior vena cava. Straining reveals valve incompetence - blood reflux, which is recorded by an ultrasound sensor. Inhalation leads to a decrease in the outflow of venous blood, tension leads to a cessation, and exhalation leads to an increase in the rise of blood to the heart.

The diameter of the vessels during the Valsava maneuver increases by 50%, which, in case of valve insufficiency, increases the pressure and reveals the reverse flow of blood. If the valves are healthy, then the test is negative. The saphenous vein can be palpated in a similar manner. When a wave appears, a conclusion is made about the incompetence of the perforating or deep veins.

Using an ultrasound sensor, pathological reflux lasting more than 0.5 seconds is determined. The maneuver is used to evaluate the saphenofemoral junction, the proximal portion of the great saphenous and common femoral vein.

Varicocele. a — B-mode: dilatation of the veins of the pampiniform plexus. b — EC mode: pronounced dilation of the veins during the Valsalva maneuver.

Straining is not always possible. The test does not work if the tone of the abdominal muscles is weak, if you are overweight, or if there is no diaphragmatic breathing (cervical spine problem). The test is modified: with the sensor installed in place of the valve, forced exhalation is performed while the doctor presses on the abdominal wall.

Schwartz test

Schwartz test was described by a French surgeon in the second half of the 19th century. Helps assess the condition of the valves of the long and short saphenous veins. The patient is placed in a standing position so that the nodes are stretched. To perform the test, the fingers of the right hand are placed along the long saphenous vein in the proximal thigh, where it connects to the deep femoral vein. Then lightly tap the knots down the leg with the left hand. If the tremors are felt with the right hand, then valve insufficiency is detected.

The test can be done in another way: with the fingers of your right hand, press on the dilated veins in the proximal part of the thigh, and with your left hand, palpate the veins of the lower leg. If the impulse is transmitted and heard by the left hand with each press, this confirms the incompetence of the valves. If the valve were functioning normally, the shock would only be felt in the next valve, since the venous lumen is limited between them. Sometimes it is difficult to detect an enlarged vein in the upper thigh, so the test is not always suitable for patients who are overweight or have deep veins.

You can use the test version proposed by McKelling and Heyerdahl. Carry out jerk-like movements in the area of the oval fossa, and with the other hand listen to them above the shin.

The Schwartz test is not related to the formula of the same name associated with determining the volume of final urine - approximately 1.5 liters or 1 ml/minute. The rate of reabsorption in the tubules is assessed, at which up to 99% of the primary substance is absorbed back into the blood. The glomeruli filter up to 180 liters per day. GFR (glomerular filtration rate) or creatinine clearance is calculated using the Schwartz formula. Renal perfusion is impaired due to hyperaldosteronism and increased production of renin during hypoxia in newborns.

Delbe Perthes marching test

The Perthes test is a physical examination technique that involves applying a tourniquet over the proximal leg. The patient is placed on the couch so that the vessels are filled, and only the superficial veins are tightened. Therefore, the pressure should not be too strong. Then he is asked to walk for 5 minutes or do calf raises. The marching test involves activating the muscle pump to empty the superficial highways. When an obstruction (thrombosis or reflux) exists in the deep venous system, activation of the gastrocnemius pump causes paradoxical filling of the superficial venous system. To check the result, the patient is placed on his back and then his leg is elevated. If varicomas distal to the tourniquet do not disappear after a few seconds, deep vein exploration should be performed.

Delbe Perthes marching test

The Delbe-Perthes marching test is questioned by many experts, since it can give a false negative result when a tourniquet is applied both below and above the blockage site. A false positive result occurs when the perforating veins are obstructed.

Noso-finger test

Among the tests, the nasal-finger test is used in neurology and is a coordination test. It determines the pathology of the cerebellum and is not used for varicose veins. The test suggests touching the tip of your nose with your outstretched hand with your eyes closed.

Troyanov-Trendelenburg test

During examination, the surgeon notes dilated veins on the limb, then the Troyanov-Trendelenburg test is performed. The patient lies on his back and his leg is elevated 60 degrees. The doctor drains the varicose veins by stroking the leg from the distal to the proximal end. There is a tourniquet around the thigh. The patient is then asked to stand up.

Troyanov-Trendelenburg test

The results are compared after 30 seconds:

Zero test - absence of rapid filling of the veins for 30 seconds with the tourniquet, and after its removal, the valves of the deep, perforating and superficial veins are competent.
A positive test - the veins collapse only after the tourniquet is removed, which means that the valves in the superficial veins are incompetent.
Double positive - the veins remain swollen both with the tourniquet and after its removal, which means that there is dysfunction of the valves of the deep and perforating vessels with reflux through the superficial vessels.
A negative test - deep and perforating valve insufficiency is recorded if within 30 seconds the vein quickly fills with blood, and after removing the tourniquet there is no increase in filling. However, filling after 30 seconds of tourniquet placement does not indicate competence of the perforating vessels.

The more deficient the superficial veins, the faster they fill with blood during the tourniquet test. The rate of decline and enlargement of subcutaneous vessels is assessed.

Pratt test

There are several sample options. The simplest of them is that the patient, lying on his back, bends his leg at the knee, grasping the lower leg with both hands and pressing the popliteal vein in the proximal part. The appearance of pain indicates deep vein thrombosis.

The second version of the Mayo-Pratt test is performed when the arteries are well patency, if the pulse in the foot is palpable. The patient lies on his back, lifts his leg, emptying the veins. A bandage is applied near the inguinal fold, squeezing the superficial vessels. The patient walks with fixation for 30–40 minutes. If pain appears in the calf area, an obstruction is diagnosed.

The third version of the test - Pratt-2 - is also carried out in a lying position. The veins are emptied by raising the leg. An elastic bandage is applied from the foot to the inguinal fold of the leg, then the tourniquet is tightened.

The patient gets up. The doctor wraps another bandage immediately under the tourniquet, and unties the second one. The bandages replace each other up to the distal part of the lower leg. The gap between them reaches 5–6 cm to see changes in varicose nodes. When they are filled, the incompetence of the valves of the perforating veins is recorded.

Pratt test

Hackenbruch test

The Hackenbruch-Sicart test, or cough test, involves the activity of the diaphragm, the relaxation of which is intended to enhance venous outflow. The doctor places his hand on the saphenofemoral junction, where the great saphenous vein ends. The patient is asked to cough several times so that the doctor listens for the appearance of a pulsation. Increased intra-abdominal pressure affects the inferior vena cava. If a push occurs under the fingers, this indicates insufficiency of the valve connecting the great saphenous and deep femoral veins - the ostial.

Hackenbruch test

Sheinis test

The three-strand test, called the Sheinis test, is performed in the supine position. The condition of perforating veins, which provide outflow from superficial vessels to deep ones, is studied. Three tourniquets are used, which are applied at the inguinal fold, at the level of the mid-thigh and under the knee. The patient is asked to rise to his feet. If the veins swell below the applied tourniquet or above the one that is removed one by one starting from the bottom, then this indicates insufficiency of the valves in a particular area.

Sheinis test

Alekseev's test

The first version of the Alekseev-Bogdasaryan test using a vessel in the shape of a boot was proposed back in 1966. The container, equipped with a tap at the top, is filled with water at a temperature of no higher than 34 degrees. First, the patient is laid down and asked to elevate his legs to clear the veins of blood. Then a tourniquet or bandage is applied at the level of the inguinal fold. The patient places his foot into the vessel, which causes the weight to displace water. The volume of liquid flowing through the tap is measured using a nearby vessel with divisions. The doctor removes the tourniquet, allowing blood to fill the veins, which increases the volume of the lower leg. A little more liquid flows out of the vessel over 15 seconds. The method allows you to evaluate arterial-venous inflow. After 20 minutes, repeat a similar procedure, applying a tonometer cuff with a pressure of 70 mm Hg under the tourniquet. In the same 15 seconds, arterial inflow is determined. The difference between the two measurements is called retrograde venous filling volume. The filling rate is calculated by dividing the volume by 15 seconds. Next, determine the degree of valve insufficiency using the table:

the first - with a volume of 11–30 ml and a speed of 0.7–2 ml/sec;
the second - 30–90 ml and 2–5 ml/sec;
third - more than 90 ml and above 6 ml/sec.

Important! Alekseev's test is performed only after a positive Troyanov-Trepdelenburg test.

Another version of Alekseev's test begins with measuring body temperature between the big and index toes. The patient then walks. If pain does not occur, then walking continues until a distance of 2000 meters is covered. Typically, in patients with thrombosis, the calves begin to hurt after 300–500 meters. Re-measurement is performed:

an increase in temperature of 1.8–1.9 degrees indicates health;
a decrease in temperature by 1–2 degrees indicates a circulatory disorder.

This version of the test determines the consistency of collateral blood supply during thrombosis.

Firta-Khizhal lobeline test

The lobeline test involves injecting an alkaloid (lobeline hydrochloride) into a vein in the foot. The substance affects the N-choline receptors of the carotid glomeruli, causing stimulation of the respiratory center. The leg is first wrapped with an elastic bandage, blocking the flow of blood through the superficial veins. The substance is administered at the rate of 1 mg per 10 kg of patient weight. If the drug does not produce a cough after 45 seconds, the patient is asked to walk and wait again for 45 seconds. Veins are considered obstructed if loberine does not rise to the vessels of the heart. If a cough appears in a lying position after removing the bandages, the diagnosis is confirmed.

The patient stands, the doctor compresses the dilated great saphenous vein. Without unclenching his fingers, he asks the patient to lie on the couch with his leg raised 60–80 degrees. If the deep veins are impassable, then blood quickly releases the saphenous vein. A furrow appears, as if from indentation of the skin.

The patient lies on his back, with the leg raised to free the superficial veins. The doctor determines the angle of compensation that is formed between the surface of the couch and the raised leg. The patient is asked to stand up and wait until the veins are filled with blood. Then the middle third of the thigh is bandaged with a tourniquet. The patient lies down on the couch again and raises his leg to the compensation angle. The veins begin to open up. If they subside quickly, then the patency of deep vessels is good. If the patency is impaired, the veins remain swollen.

Other tests for diagnosing varicose veins

There are other modifications of samples. The Myers test involves grasping and pressing the great saphenous vein against the medial femoral condyle with one hand. At the same time, the second hand is either at the level of the inguinal fold or on the lower leg. A blow is made to the veins located above and below. The strength of the blood flow determines the condition of the valves and the mouth of blood vessels. The dynamic Mayo test involves applying a tourniquet at the groin level and bandaging the leg to the foot. When walking for 30 minutes, pain that appears indicates vascular obstruction. The Morner-Ochsner test also involves applying three tourniquets while walking, but in different locations: at the top of the thigh, in the middle and at the bottom. This way you can clarify the area with incompetent perforating and deep veins.

However, the main diagnostic method includes duplex ultrasound scanning, the use of contrast agents and color mapping to determine venous reflux, thrombosis and varicose veins.

Expert opinion

Especially for the readers of our portal, we asked Dr. phlebologist Kirill Mikhailovich Samokhin from the Center for Innovative Phlebology to comment and talk about functional tests and ultrasound examinations for varicose veins:

(P. L. E. Delbet, 1861-1925, French surgeon; G. C. Perthes, 1869-1927, German surgeon)

see Marching test.

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"Delbe - Perthes test" in books

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From the book Memories and Impressions author

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From the book Letters from Lausanne author Shmakov Alexander Andreevich

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Henri Barbusse. From personal memories*

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