Non-invasive

in Chronic Venous Insufficiency and Varicose Veins

Applied

Type

Modification

Confidence

82%

Created

Apr 22, 2026

Evidence

1 source

Rationale

[citation-backfill] Refreshed the cited Rutherford line so the section wording matches the verified latest-edition support instead of only swapping the locator. The verified support snippet explicitly lists 'standing, sitting or reverse Trendelenburg (at least 15 degrees)' as proper patient positioning for assessing reflux via venous duplex scanning. The current text omits 'sitting' as an acceptable position and omits the quantifier 'at least 15 degrees' for reverse Trendelenburg. These are clinically meaningful qualifiers directly supported by the verified snippet. The citation key should also be updated to the target. The remainder of line_index=4 (reflux provocation methods and pathologic reflux thresholds) is not contradicted by the snippet and can be preserved. Line_index=12 requires only a citation key update as no claim content is challenged.

Evidence

Rutherford's Vascular Surgery and Endovascular Therapy. 10th ed.. 2022. Ch. 25, Vascular Laboratory: Venous Duplex Scanning, p. 390
10th ed.Latest verifiedCh. 25, Vascular Laboratory: Venous Duplex Scanning, p. 390
Textbook proof

for assessing reflux: standing, sitting or reverse Trendelenburg (at least 15 degrees)

Content Changes

<!-- type: diagnostic -->

**Reflux thresholds and technique:**

Duplex ultrasound should be performed with the patient standingstanding, sitting, or in reverse Trendelenburg position (at least 15 degrees) to maximize venous filling.[@rutherford2018]filling.[@rutherford-10e-2022-ch25-vascular-laboratory-venous-duple-p390-f4754d49] Reflux is provoked using distal compression and release (calf squeeze), augmentation, or Valsalva maneuver. Pathologic reflux is defined as retrograde flow lasting >0.5 seconds in superficial and perforator veins, or >1.0 seconds in deep veins.[@rutherford2018]veins.[@rutherford-10e-2022-ch25-vascular-laboratory-venous-duple-p390-f4754d49]

Systematic mapping should include:
* **Junctional reflux:** saphenofemoral junction (SFJ) and saphenopopliteal junction (SPJ)
* **Truncal reflux:** great saphenous vein (GSV) and small saphenous vein (SSV)
* **Accessory saphenous veins:** anterior accessory GSV (AAGSV) and posterior accessory GSV (PAGSV)
* **Perforator veins:** particularly in the medial calf (Cockett perforators) and thigh (Hunterian, Dodd)

Documentation should specify location, diameter, and reflux duration at each level [@rutherford2018,[@rutherford-10e-2022-ch25-vascular-laboratory-venous-duple-p390-f4754d49, @esvs2015].@esvs2015] [@rutherford-10e-2022-ch25-vascular-laboratory-venous-duple-p390-f4754d49].
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