Are venous reflux ultrasounds more accurate if performed while standing up? Is venous color duplex ultrasound diff from venous reflux ultrasound?

All of my ultrasounds have been done while lying down. I am concerned that the test results may not be as accurate because of that. Can you clarify whether it is best to have a venous reflux exam performed when lying down or standing?

Answers from doctors (10)


More About Doctor David Green, MD

Published on May 20, 2021

There are different reasons to perform venous duplex ultrasound examinations. Examinations are performed to determine the presence of blood clots as well as to assess for venous reflux. When assessing venous reflux, it is usually necessary to perform - at least part of the duplex ultrasound examination - when the patient is standing.

Answered by David Green, MD (View Profile)

There are different reasons to perform venous duplex ultrasound examinations. Examinations are performed to determine the presence of blood clots as well as to assess for venous reflux. When assessing venous reflux, it is usually necessary to perform - at least part of the duplex ultrasound examination - when the patient is standing.

Published on Jul 11, 2012


Vein Specialties of St. Louis

Published on Nov 06, 2017

Mapping of the deep veins can be done laying down. Reflux studies for superficial saphenous reflux (CVI) are done standing as gravity will best demonstrate the back flow. Both tests are the same.

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Answered by Vein Specialties of St. Louis

Mapping of the deep veins can be done laying down. Reflux studies for superficial saphenous reflux (CVI) are done standing as gravity will best demonstrate the back flow. Both tests are the same.

Published on Jul 11, 2012


Advanced Vein & Laser Centre, Ltd.

Published on Nov 02, 2017

To evaluate varicose veins, the Duplex ultrasound must be performed with the patient standing. To evaluate for deep vein blood clots the Duplex ultrasound must be performed with the patient lying flat.

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Answered by Advanced Vein & Laser Centre, Ltd.

To evaluate varicose veins, the Duplex ultrasound must be performed with the patient standing. To evaluate for deep vein blood clots the Duplex ultrasound must be performed with the patient lying flat.

Published on Jul 11, 2012


Megan E. Deacon-Casey, M.D.

Published on Nov 02, 2017

Venous Ultrasounds are more accurate if performed while standing with weight on the examined leg and the other elevated. This position enables the vein to be examined with gravity distending the vein. The vein size is typically larger and the reflux can be easily elicited with the augmentation maneuver. Is a known fact that standing worsens reflux. If the exam is performed in the lying position only, some reflux may be missed patient who are symptomatic.

Venous duplex ultrasound typically evaluates the deep system using compression, color and augmentation to evaluate for deep venous thrombosis and other abnormalities of the deep system.

Venous reflux or venous insufficiency ultrasound is usually a more detailed exam evaluating the superficial saphenous vein system using both color flow and Doppler documenting vessel size and reflux times.

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Answered by Megan E. Deacon-Casey, M.D.

Venous Ultrasounds are more accurate if performed while standing with weight on the examined leg and the other elevated. This position enables the vein to be examined with gravity distending the vein. The vein size is typically larger and the reflux can be easily elicited with the augmentation maneuver. Is a known fact that standing worsens reflux. If the exam is performed in the lying position only, some reflux may be missed patient who are symptomatic.

Venous duplex ultrasound typically evaluates the deep system using compression, color and augmentation to evaluate for deep venous thrombosis and other abnormalities of the deep system.

Venous reflux or venous insufficiency ultrasound is usually a more detailed exam evaluating the superficial saphenous vein system using both color flow and Doppler documenting vessel size and reflux times.

Published on Jul 11, 2012


Intermountain Vein Center

Published on Dec 11, 2013

You can see venous reflux while lying down. The tech will put color on the screen and ask you to either tighten your stomach muscles or bear down, which is valsalva effect. On relaxation, you can see the reflux on the screen. So yes, there has to be color on the screen to determine the reflux. It is a simple ultrasound and does not differ in technique.

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Answered by Intermountain Vein Center

You can see venous reflux while lying down. The tech will put color on the screen and ask you to either tighten your stomach muscles or bear down, which is valsalva effect. On relaxation, you can see the reflux on the screen. So yes, there has to be color on the screen to determine the reflux. It is a simple ultrasound and does not differ in technique.

Published on Jul 11, 2012


Finesse Surgical Solutions

Published on Dec 10, 2013

Venous flow characteristics and reflux are most accurately assessed in the standing position. Venous duplex scans use bi-directional color flow to detect reflux in veins. Most specialists use both grayscale (B mode) and color flow imaging.

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Answered by Finesse Surgical Solutions

Venous flow characteristics and reflux are most accurately assessed in the standing position. Venous duplex scans use bi-directional color flow to detect reflux in veins. Most specialists use both grayscale (B mode) and color flow imaging.

Published on Jul 11, 2012


Vein Center of Orange County

Published on Dec 09, 2013

You are absolutely right! Ultrasound examination for venous reflux should always be done with the patient standing for valid results. If you were lying down, I would recommend seeing another doctor. Color-flow can speed up the duplex study a bit but is not necessary to document reflux.

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Answered by Vein Center of Orange County

You are absolutely right! Ultrasound examination for venous reflux should always be done with the patient standing for valid results. If you were lying down, I would recommend seeing another doctor. Color-flow can speed up the duplex study a bit but is not necessary to document reflux.

Published on Jul 11, 2012


Heart and Vein Center

Published on Dec 07, 2013

Ideally, venous ultrasound studies should be done with the patient standing. However, in certain situations, in which the patient has severe reflux might not add much to the study. If the supine study is negative or questionable, then it is very important to repeat the study with the patient standing.

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Answered by Heart and Vein Center

Ideally, venous ultrasound studies should be done with the patient standing. However, in certain situations, in which the patient has severe reflux might not add much to the study. If the supine study is negative or questionable, then it is very important to repeat the study with the patient standing.

Published on Jul 11, 2012


Michael F. Gioscia, MD, FACS, ABVLM

Published on Dec 07, 2013

Venous duplex scans should be performed in the semi-erect position (sitting up with legs lower than torso), or the standing position. While lying supine, the correct size of the vessel as well as the degree of reflux cannot be determined accurately.

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Answered by Michael F. Gioscia, MD, FACS, ABVLM

Venous duplex scans should be performed in the semi-erect position (sitting up with legs lower than torso), or the standing position. While lying supine, the correct size of the vessel as well as the degree of reflux cannot be determined accurately.

Published on Jul 11, 2012


Vanish Vein and Laser Center

Published on Dec 06, 2013

There is controversy as to whether a venous ultrasound for reflux should be done standing or lying. Certainly lying flat is not accurate but lying with the head up and feet down (around 60 degrees) will give very accurate results. The standard answer is that a standing reflux ultrasound is the best choice, but there are several studies that challenge that. Venous color flow can be added to the duplex for a third dimension. Duplex means 2 dimensional ultrasound scanning and doppler.

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Answered by Vanish Vein and Laser Center

There is controversy as to whether a venous ultrasound for reflux should be done standing or lying. Certainly lying flat is not accurate but lying with the head up and feet down (around 60 degrees) will give very accurate results. The standard answer is that a standing reflux ultrasound is the best choice, but there are several studies that challenge that. Venous color flow can be added to the duplex for a third dimension. Duplex means 2 dimensional ultrasound scanning and doppler.

Published on Jul 11, 2012


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