Which statement distinguishes deep venous reflux from superficial venous reflux on duplex?

• A. It is exclusive to superficial veins
• B. It is detected by provocative maneuvers in all cases
• C. Deep venous reflux is more clinically significant for DVT risk
• D. Reflux always resolves with leg elevation

Answer: (C)

The key idea is where the reflux is and what it implies for risk. Reflux in the deep venous system signals valvular incompetence in the vessels that actively return blood from the leg toward the heart, and this is often linked to prior DVT or chronic venous damage. Because the deep veins are the primary pathway for venous return, reflux there has a greater impact on the risk of complications like recurrent DVT and post-thrombotic syndrome. Superficial venous reflux, while it can cause varicose veins and edema, generally carries less risk for major thrombotic events.

The other statements aren’t reliable distinctions. Reflux isn’t exclusive to superficial veins—deep system reflux exists too. It isn’t guaranteed to be unmasked only with provocative maneuvers in every case, as some reflux can be spontaneous or not easily elicited. And reflux isn’t something that reliably resolves with leg elevation, since it reflects valvular incompetence rather than reversible venous pressure changes.