Balloon Assisted Valsalva Maneuver in the Diagnosis of Saphenofemoral Junction Incompetence
Nuttawut Sermsathanasawadi MD, PhD*, Kamolrat Pattarakittikul MD*, Kiattisak Hongku MD*, Chumpol Wongwanit MD*, Chanean Ruangsetakit MD*, Khamin Chinsakchai MD*, Pramook Mutirangura MD*
Affiliation : * Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Background : Conventional Valsalva maneuver (CV) is a standard procedure to exhibit reverse venous flow at saphenofemoral
junction (SFJ) by duplex ultrasonography (DUS). However, some patients could not undergo CV during examination.
Objective : Compare blowing party balloon assisted Valsalva (PBAV) with CV for exhibiting the reverse venous flow at SFJ
incompetence.
Material and Method: Forty patients who had symptoms and signs of suspected saphenofemoral junction incompetence
were examined for venous reflux by DUS with two techniques of Valsalva maneuver, PBAV, and CV. The design was a 2x2
cross-over study. The patients were randomized to two sequences. The first sequence performed CV before PBAV. The second
sequence performed PBAV before CV. The timing for the instruction, reflux time, and total timing of examination were
compared between the two sequences.
Results : There was neither period effect nor treatment-period interaction. Both PBAV and CV could equally identify SFJ
reflux, but teaching time and total examination time in PBAV was shorter than CV.
Conclusion : PBAV is a new option to exhibit reverse venous flow at SFJ by DUS. PBAV is easier and spend less time than
CV.
Keywords : Valsalva, Venous reflux, Ultrasound
