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Value of the Trendelenburg tourniquet test in the assessment of primary varicose veins

Objective: Trendelenburg tourniquet tests should determine long saphenous vein (LSV), short saphenous vein (SSV) or perforating vein incompetence. This study analyses the inter-observer variability of the Trendelenburg test and the results are compared with duplex scanning - the standard for venous incompetence analysis. Methods: A total of 54 legs of 43 patients with varicose veins were investigated (36 female and seven male patients; mean age 47 years [range: 17-75]). All legs were evaluated for valvular incompetence by Trendelenburg tourniquet tests performed by three different investigators. A duplex scan was also performed in all legs. The inter-observer variability of the tourniquet test was expressed in Kappa (κ <0.5 indicated poor agreement). The sensitivity and specificity of the tourniquet tests are determined using the duplex scan as standard. Results: The inter-observer variability of the Trendelenburg test in detecting valvular incompetence of the LSV, SSV, perforating veins in the upper leg (PVU) and lower leg (PVL), expressed in Kappa, were: 0.39, 0.42, 0.14 and 0.49, respectively. The sensitivity of the tourniquet test in detecting valvular incompetence of the LSV, SSV, PVU and PVL, in relation to duplex scanning was: 50, 35, 52 and 35% respectively, and the specificity was 59, 72, 46 and 80%, respectively. Conclusions: The evaluation of patients with varicose veins with the Trendelenburg tourniquet test is unreliable and therefore obsolete. In order to manage patients with varicose veins properly duplex investigation is mandatory.