Another bedside test of varicose veins, devised by another German surgeon (Georg C. Perthes, the same
of Calvé-Legg-Perthes disease fame). It is aimed at determining patency of the deep venous system and
competence of the saphenous and communicating veins’ valves. It is carried out by placing a tourniquet
around the mid-thigh of a standing patient whose leg veins are fully engorged. The patient is then asked to
walk for 5 minutes, and the veins are reexamined.
If the veins below the tourniquet collapse as a result of walking, then the deep venous system is patent,
and the valves of the communicating veins are competent.
If the veins below the tourniquet remain unchanged, then the valves of both the saphenous veins, and the
communicating veins are incompetent.
If the veins below the tourniquet get more engorged (and the patient experiences leg pain), then the deep
venous system is occluded, and the communicating veins are incompetent.
Perthes’ test is based on the “milking” effect that muscle compression exercises on the greater saphenous
vein. As a result, walking squeezes blood from the saphenous veins into the communicating system and
from there into the deep veins.