Which test most accurately confirms venous insufficiency in the leg?

• A. Venous duplex ultrasound
• B. Capillary refill time
• C. Arterial Doppler ultrasound
• D. Ankle-brachial index

Answer: (A)

To confirm venous insufficiency, you need imaging that can show valve failure and backward flow in the veins. Venous duplex ultrasound does just that by combining ultrasound imaging of the veins with Doppler analysis of blood flow. It lets you see the veins’ anatomy and measure the direction and duration of flow, so you can document reflux when the patient stands or performs maneuvers like Valsalva. When reflux lasts long enough, that provides objective evidence of venous incompetence, making this test the most accurate way to confirm the condition.

Other options aren’t as specific for venous problems. Capillary refill time only assesses tiny capillaries and skin perfusion, not venous valve function. Arterial Doppler ultrasound and the ankle-brachial index evaluate arterial blood flow and pressures, which helps detect arterial disease but not venous reflux or valve incompetence.