The presence of vein reflux through incompetent vein valves is the most important pathologic finding in CVI. Reflux is measured during the release phase of the flow augmentation maneuver and during the closed-epiglottis apneic phase of the Valsalva (see Figure 18.2). It should be noted that retrograde backflow is present in normal vein valves immediately before their closure, but a cutoff value of 500 ms defines pathologic reflux in superficial, profunda femoris, and deep calf veins. The value of 350 ms is used in perforator veins and 1000 ms for femoral, superficial, and popliteal veins.20,21

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