Chapter 18: Duplex Ultrasound Imaging of the Upper Extremity Venous System Flashcards
newly formed clotted blood within a vein, generally less than 14 days old
acute thrombus
residual material present within a vein for a period of several weeks or months; also called chronic change, scarring
chronic post-thrombotic changes
a vein that is the companion vessel to an artery and travels deep to the muscular fascia and lies within the deep muscular compartments of the arm
deep vein
a vein that is superficial to the muscular fascia and the muscular compartments of the arm; travels within superficial fascia compartments; has no corresponding companion artery
superficial vein
an inward projection of the intimal layer of a vein wall producing two semilunar leaflets, which prevent the retrograde movement of blood flow
valve
thrombus appears poorly attached to the wall
acute thrombus
vein appears spongy/deformable with transducer pressure
acute thrombus
thrombus has a smooth border
acute thrombus
material in veins may appear as strands or bands
chronic post-thrombotic changes
veins may appear contracted
chronic post-thrombotic changes
material in veins may have an irregular border
chronic-post thrombotic changes
thrombus is rigid, nondeformable and firmly attached
chronic post-thrombotic changes
veins will partially compress but not able to completely coapt walls
partial nonocclusive thrombus
will augment with distal compression
partial nonocclusive thrombus
little to no change in flow pattern with Valsalva
partial nonocclusive thrombus
echogenic material around brightly echogenic, straight, parallel lines
venous catheter-associated thrombus
Virchow Triad
venous stasis
hypercoaguability
vessel wall injury
patients who present with upper extremity venous thrombosis without a history of venous puncture or cannulation
primary venous thrombosis
result of compression of subclavian vein at thoracic inlet around area of first rib
primary venous thrombosis
through to be result of years of repetitive trauma and intermittent compression of subclavian vein
primary venous thrombosis
Primary venous thrombosis is also called ______ or _____.
effort thrombosis
Paget-Schroetter syndome
Most common in young, athletic muscular males
primary venous thrombosis
most common venous thrombosis
secondary venous thrombosis
originates from use of central venous catheters or patient malignancy
secondary venous thrombosis
symptoms of venous thrombosis
unilateral arm or hand swelling
superficial palpable cord
erythema
pain
tenderness
symptoms of superior vena cava thrombosis
facial swelling
dilated chest wall collaterals
indwelling catheters
history or venous catheters
symptoms of pulmonary embolism
chest pain
tachypnea
tachycardia
While performing transducer compressions, the sonographer should compress every ____ cm
2-3
usually terminates into subclavian vein
external jugular vein
come together behind sternum to form superior vena cava
brachiocephalic vein
confluence of subclavian veins and internal jugular veins
origin of brachiocephalic veins
What two veins cannot be compressed in the upper extremity?
brachiocephalic
subclavian
Where does the cephalic vein terminate into?>
subclavian vein
Beyond the terminus of cephalic vein, the subclavian vein becomes the ______
axillary vein
travels superficially near skin line across shoulder and along arm at anterior-lateral border of biceps muscle
cephalic vein
superficial vein that connects cephalic and basilic veins
median cubital vein
terminates at junction of cephalic and subclavian veins
axillary vein
The axillary vein becomes the ____ vein
brachial
formed by junction of two radial and two ulnar veins at level of antecubital fossa
brachial vein
course along volar aspect of forearm
radial veins
course along volar aspect of ulnar side of forearm
ulnar veins
located at level where basilic vein terminates with axillary vein
basilic vein
communicates with cephalic vein via medial cubital vein
basilic vein
thin linear strands or strings of material located within venous lumen
synechaie
Normal spectral Doppler shows ___ phasicity with respiration
normal
Complete thrombus spectral Doppler
none
Partial thrombus spectral Doppler
continuous flow
pulsatile flow that displays elevated velocities throughout cardiac cycle
upper extremity hemodialysis fistula or graft
will appear in lumen of vein as bright, straight, parallel echoes
venous catheter
What is the most common reason that secondary venous thrombosis in the upper extremities has become more common?
increased injury to vein walls
Unlike the lower extremities, what do the upper extremities NOT have that may allow spontaneous thrombus formation?
soleal sinuses
What is primary venous thrombosis due to compression of the subclavian vein at the thoracic inlet termed?
Paget-Schroetter syndrome
A patient presents to the vascular lab for upper extremity venous evaluation with face swelling and prominent veins on the chest and neck. What do these findings suggest?
superior vena cava thrombosis
Transducer compressions are limited over several veins in the upper extremity because of limited access from bony structures. What are the most common veins that are NOT able to be compressed?
brachiocephalic and subclavian veins
What is the most appropriate transducer for mapping of the upper extremity superficial venous system?
10-18 MHz straight linear array
Why are the subclavian and jugular veins assessed with the patient lying flat?
to reduce hydrostatic pressure
How does the external jugular vein lie in relation to the internal jugular vein?
posterior
At the confluence with which vein does the brachial vein become the axillary vein?
basilic vein
During an upper extremity venous examination, the technologist has made the patient take in a quick, deep breath through pursed lips while viewing the subclavian vein. What is the purpose of this action?
collapse/coapt the subclavian vein
In the upper extremity, in general, which venous system is larger?
a. deep systep
b. superficial system
c. deep and superficial are of equal size
d. perforating system
b
During an upper extremity venous duplex examination, the technologist notes significant pulsatility in the spectral Doppler waveform from the internal jugular vein. What does this finding suggest?
normal finding for the IJV
Which vessel may NOT be routinely evaluated in a UE venous duplex examination but is often added in the event of significant thrombosis?
external jugular vein
Because of the location of the brachiocephalic veins, documentation of patency of these vessels is usually performed with which of the following?
a. grayscale image with additional color flow spectral Doppler images
b. grayscale imaging alone
c. grayscale image with and without transducer compression
d. color-flow imaging alone
a
Which vessel connects the basilic and cephalic veins?
medial cubital vein
Which forearm vessels are NOT routinely evaluated during upper extremity venous duplex testing?
a. basilic and cephalic veins
b. basilic and ulnar veins
c. cephalic and radial veins
d. radial and ulnar veins
d
A 34 year old female presents to the vascular lab with a 1 day history of arm swelling and redness. The patient has recently had a PICC line inserted. During the duplex evaluation, the axillary and subclavian veins are incompressible and are dilated with spongy-appearing, hypoechoic echoes noted within their lumens. What do these findings suggest?
acture venous thrombosis
A 78 year old male presents to the vascular lab with right arm swelling for the past several days. The patient notes that he is currently being treated for cancer. During the upper extremity duplex examination, decreased pulsatility is noted in the right internal jugular and subclavian ceins as well as Rouleaux (slow) flow formation. What do these findings suggest?
a more proximal obstruction, likely in the brachiocephalic vein or superior vena cava
During an upper extremity venous duplex evaluation, color flow is noted filling the axillary vein. However, in a transverse view, the axillary vein is noted to be only partially compressible. Which of the following could explain these findings?
a. color priority set too low and color gain too high
b. color scale too high and color gain too low
c. color priority and scale too high
d. color packet size and gain too low
a
A 22 year old male patient presents to the vascular lab with a 3 day history of left arm swelling with no apparent injury or risk factors. upon further questioning, the patient does state that he has recently begun weight training. What does the vascular technologist suspect in this patient?
effort thrombosis
The ____ veins of the arm are more affected by venous thrombosis than in the legs.
superficial
Signs and symptoms of upper extremity venous thrombosis are ____ to symptoms in the lower extremity.
similiar
Thrombosis in the upper extremity veins is now most commonly caused by more frequent introduction of ____ and ____ into arm veins
catheters
needles
Common veins to use for catheter placement and, therefore, for venous thrombosis are the _____ vein and the ____ vein.
subclavian
internal jugular
Veins that are typically used for the insertion of a PICC line are the _____ veins or the ____ veins.
basilic
cephalic
Individuals who present with upper extremity thrombosis secondary to compression of the subclavian vein at the thoracic inlet have what is termed _____ thrombosis or _____ syndrome.
effort
Paget-Schroetter
Superior vena cava syndrome often causes facial _____ and prominent, dilated ____ collateral veins.
swelling
chest wall
_____ patients may present for upper extremity venous evaluation before catheter placement, venous mapping for bypass, and before placecment of pacemaker wires/
Asymptomatic
As in the lower extremities, gentle compression with the transducer is applied over upper extremity veins to cause the walls to ____.
compress
Compression of the _____ and _____ veins is usually not performed because of the position of these vessels in relation to the bony structures of the shoulder.
brachiocephalic
subclavian
To evaluate the internal jugular, brachiocephalic, subclavian, axillary, and brachial veins, a _____ MHz transducer is typically used; however, it is helpful to use a ____ Mhz transducer when evaluating small forearm veins as well as superficial extremity veins.
5-10
10-18
When sitting up or lying with the head elevated, hydrostatic pressure causes hte jugular and subclavian veins to _____; therefore, it is preferable to evaluate these vessels witht he patient lying ____.
collapse
flat
Evaluation of the jugular veins should be included in the upper extremity evaluation because they can be involved in the _____ process or can provide ______ pathways in the presence of upper extremity thrombosis.
thrombus
collateral
The typical landmark used to identify the internal jugular vein is the ____ artery.
carotid
Spongy, poorly attached, hypoechoic material visualized within the lumen on a noncompressible, dilated vein is consistent with _____ venous thrombosis.
acute
Flow reversal in the internal or external jugular veins is often associated with ipsilateral _____ vein thrombus.
brachiocephalic
The median cubital vein connects the cephalic and basilic veins and is commonly used for _____.
venipuncture
In veins that are partially thrombosed, the spectral Doppler signal is typically _____ in nature but should display augmentation with distal compression.
continuous
One method to help determine patency of the central veins is to compare the _____ of the signal from the right or left sides.
symmetry
Spectral Doppler characteristics of the upper extremity venous system include respiratory ______ and pronounced ______ in the more centrally located vessels.
phasicity
pulsatility
