The Trendelenburg maneuver is used to assess venous valvular competency in the communicating veins, as well as in the saphenous system. A tourniquet is placed around the patient's upper thigh after it has been elevated 90° for 15 to 20 seconds. The tourniquet occludes the great saphenous vein and should not occlude the arterial pulse. The patient is then instructed to stand while the examiner watches for venous filling. The saphenous vein should fill slowly from below in about 30 seconds as the femoral artery pushes blood through the capillary bed into the venous system. Rapid filling of the superficial veins from above indicates retrograde flow through incompetent valves of the communicating veins. After 30 seconds, the tourniquet is released. Any sudden additional filling also indicates incompetent valves of the saphe-nous vein.
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