Ch 8 Venous Valvular Testing Flashcards
What is the anterior GSV?
Superficial vein at the anterior thigh
What does CEAP stand for?
Clinical, etiologic, anatomic, pathophysiologic (classification of venous disease)
What is chronic venous insufficiency?
Long lasting venous valvular or obstructive disorder
What is elastic compression?
The effects of stockings used to compress the leg, with intent to compress the veins
What is lipedema?
Swelling of fat tissue
What is plethysmography?
-Graphic presentation of pulses
-It measures changes in volume in different parts of the body
What is reflux?
Reverse flow, m/c in veins with incompetent valves
What is a reticular vein?
Superficial vein less than 3mm
What is a spider vein?
-Small clusters of veins near the skin surface that are red, blue or purple + measure b/w 0.5-1mm
-Aka telangiectasias
What is a tributary vein?
Vein that terminates/empties into another larger vein
Measurement for a varicose vein?
> 3mm
What is the vein of giacomini (VOG)?
Extension of SSV to GSV within a saphenous fascia
What is CVVI?
-Chronic venous valvular insufficiency
-Occurs in deep or superficial veins with incompetent valves + reflux
Do most pt’s with CVVI have venous obstruction?
No!
Which vein is the primary concern in CVVI?
GSV
(easily seen at the groin/SFJ as the medial mickey mouse ear OR in the thigh bordered by the deep + superficial fascia creating the egyptian eye look)
GSV hypoplasia/agenesis is common where?
Below the knee
Differentiate b/w true GSV duplication + superficial/accessory veins?
True: 2 veins staying within saphenous part
Superficial/Accessory: coursing in + out the saphenous part
The prox GSV has 2 major valves, what are they?
-Terminal valve (0.4cm from SFJ)
-Preterminal valve (3.1cm from SFJ)
The SFJ tributaries join the GSV b/w what valves?
The terminal + preterminal valves
What is AAFSV?
Anterior accessory GSV (is anteromedial in thigh + empties into SFJ)
What is PAGSV?
Posterior accessory GSV (lies deep to GSV in thigh)
The m/c SSV termination is where?
At the Pop V via the SPJ
(note there are 3 other SSV variations)
What is the function of persistent sciatic veins?
-Functions as collateral pathways for the FV
-The sciatic vein is deeper in the thigh + adjacent to the sciatic nerve
What is venous valvular insufficiency testing?
Venous reverse flow (reflux) detection
Explain the anatomy behind valves?
-Unidirectional
-More valves with distance away from the heart
-Open with contraction, close with relaxation
Incompetent valves cause abnormal retrograde flow/reflux, what does this cause?
An increased volume of blood in the lower leg
List the 3 types of disorders that affect LE venous bicuspid valves?
Valve agenesis: is congenital (reflux occurs at any time)
Valve damage: caused by DVT or degeneration due to age (reflux occurs at any time)
Valve leakage: due to venous dilatation, the vein is too big for the valve to close properly (reflux occurs intermittently)
What 2 things are varicose veins associated with?
Valve reflux + venous obstruction
List the clinical CEAP classification?
C0: no signs/symptoms
C1: spider or reticular veins (<3mm)
C2: varicose veins (>3mm)
C3: edema
C4: skin changes
C5: healed skin ulcers
C6: open skin ulcers
(view chart in slides for full CEAP)
What is VCSS?
-Venous clinical severity score
-Used to assess those with venous disease that is complementary to the CEAP classification
(score varies b/w 0-30)
U/s exam for CVVI has what 2 key diagnostic goals?
-To exclude deep venous obstruction or acute thrombosis
-To evaluate the function of valves, or reflux detection
What is the pt prep for valvular testing?
-Get pt to remove clothes from waist down
-Deep veins are imaged first in reverse trendelenburg
-Superficial veins are imaged while pt stands
Is detecting acute DVT rare?
Yes!
Normal antegrade flow should be ___ the baseline?
Below
Abnormal retrograde flow should be ___ the baseline?
Above
What does the valsalva maneuver test?
Reflux in the CFV + prox GSV, at the SFJ
(does not test more distal veins)
What does the parana maneuver test?
Valves above + below knee (calf muscle must pump)
What do foot flexion + toe curls do?
Causes calf muscle contractions
What do hand compressions do?
The tech can squeeze the distal leg being tested for a variety of conditions
Chronic venous valvular insufficiency (CVVI) may present with an increase in what?
Collateral vein diameters, but the veins are still completely compressible
How will the valves + affected veins appear with CVVI on 2D?
Valves: Thickened leaflets
Veins: tortuous, varicose or aneurysmal
How will CVVI appear on spectral doppler + CD?
SD: Reverse/reflux flow seen following prox or distal compression
CD: Retrograde turbulent flow within valve sinuses
How fast does the saphenous, deep femoropopliteal + perforating vein valves close?
Saphenous: <0.5 sec
Deep FP: <1 sec
Perforating: <0.35 sec
(longer duration’s = abnormal reflux)
Treatment options for superficial CVVI?
Traditional: Ligation with or w/o stripping + phlebectomies
Present: Sclerotherapy (chemical ablation), thermal ablation + cyanoacrylate glue occlusion
(ablation has replaced stripping + ligation)
