In a patient with suspected venous insufficiency presenting with distal leg discoloration, which examination technique best screens for the condition?

• A. Capillary refill time
• B. Dorsalis pedis pulse
• C. Sensory filament testing
• D. Venous filling time

Answer: (D)

Venous filling time directly tests how well the leg’s venous system returns blood when it’s dependent, which is the core issue in venous insufficiency. The test involves letting the leg drain and then lowering it to observe how quickly the superficial veins refill. If the veins fill rapidly on standing, it indicates venous reflux from incompetent valves, which matches venous insufficiency and the observed discoloration. If refill is slow or normal, arterial issues or other causes are less likely. This makes it the most appropriate screening tool for suspected venous insufficiency.

Capillary refill time mainly reflects arterial perfusion in the digits and can be influenced by temperature or other factors, so it’s not a reliable screen for venous problems. Checking the dorsalis pedis pulse assesses arterial inflow, not venous return. Sensory filament testing evaluates nerve function, not venous circulation.