If a symptomatic patient does not show venous reflux in the supine position, what should be done next?

When a symptomatic patient does not show venous reflux in the supine position, it is important to assess the patient further through additional testing that may provide more insight into their condition. Conducting a repeat ultrasound in the standing position is a logical next step. This is because venous reflux and other abnormalities may not be evident while the patient is lying down. By moving the patient to a standing position, you can evaluate the venous system under the effects of gravity, which can reveal pathologies such as insufficiency that are not present in the supine position.

Performing the ultrasound again while the patient is standing allows for a more comprehensive assessment of how the veins function in a typical daily scenario, thus potentially providing critical information necessary for appropriate diagnosis and treatment planning. This step is particularly relevant in phlebology, where changes in position can significantly influence venous function.