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Venous Valve Function Test – Diagnosis & Procedure

The venous valve function test evaluates how well the valves in the leg veins are working. It helps diagnose venous diseases such as varicose veins or chronic venous insufficiency.

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The venous valve function test evaluates how well the valves in the leg veins are working. It helps diagnose venous diseases such as varicose veins or chronic venous insufficiency.

What is the Venous Valve Function Test?

The venous valve function test is a diagnostic procedure used to assess the function of the venous valves in the leg veins. Venous valves are small, flap-like structures inside the veins that ensure blood flows in only one direction – toward the heart. When these valves are damaged or fail to close properly, blood can flow backward, a phenomenon known as venous reflux. This can lead to blood pooling and various venous disorders.

The test is commonly used in phlebology (the medical specialty dealing with veins) and vascular surgery as a key part of the diagnostic workup for suspected varicose veins, chronic venous insufficiency (CVI), or deep vein thrombosis.

How Does the Test Work?

Several methods are available to assess venous valve function. The most commonly used include:

Duplex ultrasound (colour duplex sonography): This is the gold-standard method. Ultrasound imaging visualises the veins while simultaneously measuring blood flow. Reflux detected during breathing manoeuvres or manual compression indicates valve incompetence.
Phlebodynamometry: This technique directly measures venous pressure to evaluate valve performance.
Photoplethysmography (PPG) and light reflection rheography (LRR): These non-invasive methods measure changes in blood volume within the lower leg veins, providing indirect information about valve function.
Clinical tests: Classic physical examination techniques such as the Trendelenburg test and the Perthes test have traditionally been used to evaluate venous valve competence, although they have largely been replaced by imaging methods.

When is the Test Indicated?

The venous valve function test is recommended in the following situations:

Visible or palpable varicose veins in the legs
Heaviness, pain, or swelling in the legs
Suspected chronic venous insufficiency
Skin changes such as pigmentation or leg ulcers (ulcus cruris)
Follow-up after vein surgery or sclerotherapy
Investigation following a deep vein thrombosis (DVT)

What Does the Test Measure?

The primary aim of the test is to determine whether venous valves are closing properly. Specifically, it measures:

Whether reflux is present and to what extent
The reflux duration: a reflux lasting more than 0.5 seconds in superficial veins or more than 1 second in deep veins is considered pathological
The affected venous segments (superficial, deep, or perforating veins)

How is the Examination Performed?

The examination is generally painless and non-invasive. The patient may lie down or stand depending on the method used. During duplex ultrasound, an ultrasound probe is placed on the skin with a special gel to ensure clear imaging. The patient is often asked to take a deep breath, exhale, or perform muscle movements such as standing on tiptoes to alter venous blood flow and observe how the valves respond.

Clinical Relevance of Results

The results of the venous valve function test help the physician to:

Assess the severity of venous disease (e.g., according to the CEAP classification)
Select the most appropriate treatment (e.g., compression therapy, sclerotherapy, or surgical intervention)
Monitor the success of treatment after therapy

Risks and Side Effects

The venous valve function test is generally very safe. Non-invasive methods such as duplex ultrasound and photoplethysmography carry no known risks. Invasive pressure measurements such as phlebodynamometry may rarely cause minor local skin reactions.

References

Deutsche Gesellschaft für Phlebologie (DGP): Guideline on the Diagnosis and Treatment of Varicosis. AWMF Register No. 037/018, 2019.
Nicolaides AN et al. - Management of chronic venous disorders of the lower limbs. International Angiology, 2014;33(2):87-208.
Rabe E, Pannier F. Clinical examination and instrumental diagnostics in venous disease. In: Phlebology, Thieme Verlag, Stuttgart, 2012.

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