Trendelenburg test (varicose veins)

From Ganfyd

A test described by the German surgeon, Friedrich Trendelenburg

A test to assess the competence of the sapheno-femoral junction (SFJ). Some textbooks refer to the Trendelenburg test and the Tourniquet test interchangeably. However, other sources describe the Trendelenburg test as being essentially identical to the Tourniquet Test, but finger pressure is used to occlude the SFJ instead of a tourniquet.

Procedure

In both cases, the procedure is almost identical. With the patient in a supine position, the lower limb is elevated to empty the superficial venous system. In the case of the Tourniquet test, a tourniquet is applied just below the level of the SFJ.

The patient is then asked to stand. Rapid filling of the varicosities with the tourniquet still on suggests incompetent perforators below the level of the SFJ. If no filling is seen at this point, the tourniquet is released. Rapid filling of the varicosities at this stage suggests SFJ incompetence.

From the practical point of view, the Tourniquet test is easier to perform as it is difficult to maintaining adequate finger pressure while attempting to get the patient from lying down to standing up. With a tourniquet, the test can be repeated at successive levels down the leg, giving an approximate location of the incompetent perforators.

Utility

The sensitivity and specificity of these tests is limited and modern assessment of varicose veins is performed either with hand-held doppler, or in more difficult cases, formal duplex studies.^[1][2]

References