During examination of a patient with varicose veins, the great saphenous vein is emptied by elevating the leg, a tourniquet is applied just below the knee, and the patient stands. The varicosities remain collapsed. What does this finding indicate?

• A Competent perforators below the tourniquet with the source of reflux above it ✓
• B Perforator incompetence below the level of the tourniquet
• C Deep venous obstruction
• D Saphenofemoral junction incompetence

Explanation

In the modified Perthes or tourniquet test, if varicosities stay controlled by a below-knee tourniquet, the incompetent communicating point lies above the tourniquet, typically the saphenofemoral junction, while the perforators below are competent. Saphenofemoral incompetence alone would still be consistent, but the specific inference tested is that below-knee perforators are competent. Deep obstruction would cause the veins to fill rapidly and the limb to feel tense on standing.

Reference: Bailey and Love's Short Practice of Surgery, 28th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.