Clinical exam · Cardiovascular system
Varicose veins: the Trendelenburg (Brodie–Trendelenburg) test !
- Maneuver
Emptying the veins with the leg raised, applying a tourniquet and watching how they fill on standing shows where the valves fail.
Updated 2026-11-01
See it in 3D: Great saphenous vein · Small saphenous vein · Femoral vein · Popliteal vein
What it is
The Brodie–Trendelenburg test localizes reflux in varicose veins: at the saphenofemoral junction or in the perforating veins. It is a classic exam maneuver; duplex ultrasound now replaces it for treatment decisions, but it is still an exam question.
The anatomy it tests
- The great saphenous vein runs up the medial leg and thigh and joins the femoral vein at the saphenofemoral junction; the small saphenous drains into the popliteal.
- Perforating veins connect the superficial and deep systems; their valves let blood pass inward only.
- With competent valves the superficial veins fill slowly from below, from capillary arterial inflow.
How to do it
- Inspect the legs with the patient standing: course of the varicosities, edema, color changes, eczema, ankle ulcers.
- Lay the patient down and raise the leg to about 45 degrees to empty the superficial veins (stroking toward the thigh helps).
- Apply a tourniquet (or finger pressure) high on the thigh, below the saphenofemoral junction, without occluding the arteries.
- Ask the patient to stand and watch the veins fill for about 30 seconds with the tourniquet on.
- Remove the tourniquet and watch whether the veins fill suddenly from above.
What a positive result means
- Veins empty with the tourniquet that fill suddenly on release: saphenofemoral junction incompetence.
- Veins that fill quickly even with the tourniquet on: incompetent perforators below the tourniquet (or the small saphenous).
- Rapid filling in both phases: combined incompetence.
- Slow filling from below over about 30 seconds or more: competent valves.
Usefulness and limits
- It is imprecise and operator-dependent; duplex ultrasound localizes reflux and assesses the deep system.
- Not done with acute venous thrombosis or infected ulcers; watch for dizziness on standing.
Test yourself
Think of the answer, then tap the question to see it.
Where is the tourniquet placed in the Brodie–Trendelenburg test?
High on the thigh, below the saphenofemoral junction, with the leg raised and the veins emptied.
What does rapid filling with the tourniquet still on indicate?
Incompetent perforators below the tourniquet (or reflux through the small saphenous vein).
Which test now replaces this maneuver?
Venous duplex ultrasound, which localizes reflux and assesses the deep veins.
See it in 3D
The structures of Durgical's 3D anatomy where it is found.
Related
- Signs of deep vein thrombosis: Homans and the Wells score
- Edema: pitting, grading and distribution
- Peripheral pulses and the ankle–brachial index
Related conditions
Educational content on the clinical exam; it is learned and practised under supervision. It does not replace assessment by a health professional and is not for self-diagnosis.
Sources: Varicose veins: MedlinePlus Medical Encyclopedia (MedlinePlus, U.S. National Library of Medicine, 2026); 6.4 Bedside Physical Assessment in Medical-Surgical Nursing - Medical-Surgical Nursing | OpenStax (OpenStax (Rice University), 2024).
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Representative model, for educational purposes only.