Chapter 19: ultrasound evaluation and mapping of the superficial system Flashcards
A superficial vein forming at the level of the medial malleleous, coursing medially along the calf and thigh, and terminating into the common femoral vein at the saphenofemoral junction
Great saphenous vein
A vein that connects the superficial venous system to the deep venous system
Perforating vein
A vein that was previously thrombosed
Recanalization
A superficial vein that courses along the posterior aspect of the calf, terminating at the popliteal fossa into the popliteal vein
Small saphenous vein
Dilated tortuous superficial veins
Varicosities
Accessory saphenous vein
Anterior or posterior accessory great saphenous vein
Leonardo’s vein
Posterior accessory great saphenous vein
Posterior arch vein
Posterior accessory great saphenous vein
Vein of Giocomini
Cranial extension of the small saphenous vein
How to increase vein diameter?
Maximize venous pressure
Keeping the patient warm reduces:
Vasoconstriction
Using gel sparingly:
Reduces cooling of skin
Helps put ink on skin
Keep the transducer ______ to the skin surface.
Perpendicular
Tortuous dilated segments of veins
Varicosities
Thickened vein walls often with an irregular surface
Recanalization
Bright white echoes within vessel wall with acoustic shadowing
Calcifications
Valve leaflet protruding into vessel lumen and frozen in place
Stenotic valves
Courses slightly anterior near tibia, and then continues up into thigh as a single trunk, coursing medially and terminating into the common femoral vein
Great saphenous vein
Vein that perforates or penetrates the muscular fascia of the leg and connects superficial system to deep system
Perforating veins
What happens if the vein is arterialized and the perforating vein is left intact?
Creation of an arteriovenous fistula
Two smaller veins leave foot and travel medially and laterally along Achilles tendon and join together to form ——-
Small saphenous vein
Typically a single trunk that courses up the middle of the posterior aspect of the calf
Small saphenous vein
Terminates into popliteal vein
Small saphenous vein
Begins at level of wrist, courses along radial aspect of forearm, terminates into subclavian vein
Cephalic vein
Begins at level of wrist, courses along ulnar aspect of forearm, joins brachial veins to form axillary vein
Basilic vein
The basilic vein and cephalic vein communicate at______ via _______
Antecubital fossa
Medial cubical vein
To ensure venous pressure is maximized, the patients limb should be placed _______.
Dependent position
To image GSV, one would position the patient how?
Reverse Tremdelenburg position with hip externally rotated and knee slightly flexed
To image the small saphenous vein, the patient should be positioned:
On side with posterior aspec of calf accessible
How to measure vein wall size correctly
Anteroposterior
How long does liquid ink take to dry?
3-5 minutes
How long does liquid ink stay visible?
3-5 days
Normal valve sinuses appear:
Elliptical
Normal valve leaflets appear:
Freely moving with any evidence of thrombus behind leaflets
Minimal vein diameter suited for bypas
2.5-3.0 mm
Which of the following characteristics are assessed during preoperative evaluation of the superficial venous system?
A. Vein patency
B. Vein depth and size
C. Vein position
D. All of the above
D
How many common configurations does the thigh portion of the GSV have?
Five
What is a vein that penetrates the muscular facia of the leg and connects the superficial system to the deep system?
Perforating vein
To maximize venous pressure and distinction, in what position should the patients limbs be placed when mapping the superficial venous system?
Dependent
What measures can be taken to ensure that a patients vessels do not vasoconstrict?
Keep the exam room warm and cover the patient, only exposing the limb being evaluated.
Because the superficial veins are under low pressure and just under the skin, what type of transducer compression must be used to compress these veins?
Light
Which of the following describes the proper technique for marking a superficial vein in a longitudinal image orientation?
A. Vein should appear ovoid in shape; transducer should be perpendicular to skin surface
B. Vein should appear ovoid in shape; transducer should be oblique to the skin surface
C. Vein should fill the screen from left to right; transducer should be perpendicular to skin surface
D. Vein should fill the screen from left to right; transducer should be oblique to the skin surface
C
At what distance should makes be placed along the length of the vein when marking?
2 to 3 cm
When mapping and marking the superficial veins, what is the transverse orientation useful to help identify?
Branch points and vein diameter
When measuring vein diameters for use as a conduit, how should the veins be measured?
Inner wall to inner wall
In which part of the arm are the superficial veins easiest to identify?
Upper arm
Why are the vessels easier to identify at the upper arm?
The vessels are larger and have the least amount of branches
Which landmark can be used to identify the cephalic vein in the upper arm?
Biceps muscle
Which transducer frequency would be most appropriate for mapping of the cephalic vein?
A. 7 MHz
B. 3.5 MHz
C. 10 MHz
D. 15 MHz
D
During a vein mapping procedure, the technologist visualizes a portion of the GSV that is partially compressible with decreased phasicity upon Doppler interrogation. What does this most likely represent?
Partial thrombosis of the GSV section
Which condition results in a vein that is unusable as a bypass conduit?
A. Wall thickening with evidence of recanalization
B. Vein wall calcifications
C. Isolated valve abnormalities
D. All of the above
D
During a venous mapping procedure, the patient notes that she has had prior vein stripping; however the technologist finds a large superficial vein on the anterior medial aspect of the thigh. What does this most likely represent?
The anterior accessory saphenous vein, which has become dominant
What minimum size is required for a vein to be used as a conduit?
2.5 to 3.0 mm
During a venous mapping procedure, the technologist notes a thin, Echogenic line protruding into the vessel lumen that does not appear to be mobile. The patient does not have a history of previous superficial thrombophlebitis. What does this finding likely represent?
Stenotic, frozen valve
When using color and spectral Doppler to evaluate the superficial venous system, which settings should be used?
High gain and low PRF/scale
A common application for superficial venous mapping is to evaluate veins for use as lower extremity or coronary ___.
Bypass
The _____ vein is the standard name for the vein previously known as the lesser or short saphenous vein.
Small saphenous
If the great saphenous vein has been removed, the ______ systems may be a suitable alternative.
Accessory
Venous mapping of the upper extremity veins is routine in the preoperative assessment for patients undergoing the creation of ______.
Hemodialysis access
When using a superficial vein for in situ arterial bypass, _______ veins must always be identified and ligated.
Perforating
The cephalic vein courses up the ______ side of the forearm, whereas the basilic vein courses up the ____ side of the forearm.
Lateral
Medial
The main GSV is typically bounded superficially by the _______ and deeply by the _______.
Saphenous fascia
Muscular fascia
There are several common configurations in the GSV. Most often, there is a single trunk that runs ____[ in the thigh.
Medially
When a double saphenous system occurs, it is important to distinguish which system is ____ so the surgeon can select appropriately
Dominant
The small saphenous vein is typically a single trunk that courses up the middle of the posterior aspect of the calf and terminates into the ______ vein.
Popliteal
When mapping directly onto the patient’s skin, limited use of gel will allow easier marking on the skin and reduce the amount of ______ the patient experiences because of gel evaporation
Cooling
The optimal patient position for mapping of the GSV is a _____ with the hip externally rotated and knee flexed.
Reverse trendelenburg position
When starting to map the GSV, it can be identified at the ______ junction in a transverse orientation using light probe pressure.
Saphenofemoral
If using a longitudinal approach to vein mapping, the technologist should be sure that the vein completely fills the screen from right to left and that the transducer is ______ to the skin surface.
Perpendicular
When mapping a vein, two types of branches should be identified: _______ branches and deep ______ veins
Cuteaneous
Perforating
Because of how vein diameters are measured, vein sizes are often _____ when compared to intraoperative measurements.
Underestimated
Appropriate system settings for venous mapping include adjusting the transmit power and focal zones for a well-defined \____ field image and adjusting Doppler settings to detect _____.
Near
Slow flow
Keeping the patient warm during a vein mapping procedure helps to reduce peripheral _______.
Vasoconstriction
Diabetics and patients with end-stage renal disease can often have venous ______ that may make a vein unsuitable for bypass material.
Calcifications
Veins presenting with an irregular intimacy surface or wall thickening may indicate evidence of _____.
Recanalization
