Samet GENEZ, Erdal AYVAZ, Yunus YILMAZSOY, Hamza ÖZER
Kocaeli Üniversitesi Sağlık Bilimleri Dergisi - 2026;12(2):115-118
Objective: To evaluate the effect of patient positioning on duplex ultrasound (DUS) findings in lower-extremity varicose veins, with particular emphasis on changes in saphenous vein diameter and reflux detection between the supine and standing positions. Methods: This retrospective study included 72 patients involving 126 extremities who underwent DUS for suspected venous insufficiency between January and May 2019. Adult patients with primary varicose veins and no history of venous surgery were included, whereas those with a history of deep vein thrombosis, pregnancy, active skin infection, or significant peripheral arterial disease were excluded. All examinations were performed using a Toshiba Aplio 500 ultrasound system equipped with a 14-7.2 MHz linear-array transducer. DUS examinations were performed by two radiologists, each with more than five years of experience in vascular ultrasonography. Great saphenous vein (GSV) diameters were measured at the saphenofemoral junction and distal thigh, and small saphenous vein (SSV) diameter was measured at the saphenopopliteal junction. Reflux times were assessed in the GSV at the saphenofemoral junction and distal thigh in both positions. Pathological reflux was defined as retrograde flow lasting >=0.5 s. Statistical analyses were performed using Student's t-test, the Mann-Whitney U test, and the chi-square or Fisher's exact test, as appropriate. A p value <0.05 was considered statistically significant. Results: Compared with the supine position, standing examination showed significantly larger GSV and SSV diameters (p<0.001 for all) and improved visualization of varicose veins (p<0.05). Reflux prevalence at the saphenofemoral junction increased slightly from 72.3% to 78.6%, without statistical significance (p=0.24), whereas reflux at the distal thigh increased significantly from 17.5% to 37.3% (p<0.001). Conclusion: Standing examination increases saphenous vein caliber and improves reflux detection, particularly in distal segments, and should therefore be used for pre-interventional reflux mapping whenever feasible.
