Chapter 20: Venous valvular insufficiency testing Flashcards by Billie Harney

Superficial vein at the anterior thigh within a saphenous fascia

Anterior accessory great saphenous vein

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Clinical etiologic anatomic pathophysiologic classification of venous disease

CEAP

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Chronic venous insufficiency involving venous valvular malfunction; no obstructions

Chronic venous valvular insufficiency

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Term describing the effects of increased pressure stockings that compresses the leg and its veins

Elastic compression

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superficial vein in the medial calf, knee, and thigh within a saphenous fascia with variations in anatomy among patients

great saphenous vein (GSV)

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leg swelling

leg edema

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swelling attributed to fat tissue, most commonly painful

lipedema

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swelling attributed to lymph channels or lymph node disorders

lymphedema

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superficial veins exclusive of the saphenous systems. May originate from a gluteal, vulvular, posterolateral thigh-knee perforators, lower posterior thigh, popliteal fossa tributaries, and sciatic nerve vein source; also includes neovascularization

nonsaphenous veins

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graphic presentation of waveforms that reflect temporary changes of regional venous volume

plethysmography

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superior vein, posterior medial thigh within a saphenous fascia

posterior accessory great saphenous vein

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abnormal reverse flow in veins with incompetent or absent valves

reflux

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superficial dermal vein with diameter measuring less than 3 mm

reticular vein

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term for telangiectasias, a small cluster of vessels at the skin surface that may be red, blue, or purple with diameters between 0.5 mm and 1 mm

spider vein

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superficial vein in the posterior aspect of the calf within a saphenous fascia

small saphenous vein

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a vein that terminates or empties into another; often truncal vein

tributary vein

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superficial vein with diameter measuring 3 mm or greater

varicose vein

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extension of SSV to GSV within a saphenous fascia

vein of Giacomini

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vein diameter enlarged
valve sinuses enlarged
tortuosity, varicosities or venous aneursyms

B-mode ultrasound findings of CVVI

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saphenous veins and tributaries retrograde flow >500 ms
deep veins retrograde flow > 1.0 s
perforating veins retrograde flow > 350 ms

Spectral Doppler ultrasound findings of CVVI

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Retrograde color flow
turbulent or multiple color patterns seen within valve sinuses

Color-flow imaging

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Patients presenting with CVVI do not have _____

venous obstruction

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unceasing valvular insufficiency

due to valve damage

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intermittent valvular insufficiency

function of venous dilatation

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reversed flux of blood

CVVI

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CEAP classificaion

clinical
etiologic
anatomic
pathphysiologic

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most commonly primarily CVVI concern

Great saphenous vein

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The greater saphenous vein is located in the saphenous compartment between ______ and ______.

superficial saphenous fascia
deep muscular fascia

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Identification of the GSV below the knee is aided by the _____ sign in cross-sectional imaging

triangle sign

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components of the triangle sign

gastrocnemius muscle
tibial bone
saphenous fascia

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two major valves at or near the SFJ

terminal
preterminal

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The terminal valve is located ____ cm from the actual SFJ

0.4

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The preterminal valve is located ____ cm from the actual SFJ

3.1

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______ and _____ valves in femoral vein influence SFJ flow

suprasaphenic
infrasaphenic

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can occur distally to a normal terminal valve or even distally to both valves

perijunctional GSV reflux

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common SFJ tributaries

superficial external pudendal
superficial circumflex iliac veins

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landmark for saphenous ablation treatment

superficial inferior epigastric vein

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identifies anterior accessory great saphenous vein in upper thigh
AAGSV and deep femoral vessels form a straight line perpendicular to transducer in cross sectional image

alignment sign

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anterolateral in calf, crosses around knee to an anteromedial position in the thigh, and terminates at the SFJ

AAGSV

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posterior to GSV in thigh and calf

PAGSV

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calf segment of PAGSV

Leonardo vein/ posterior arch of GSV

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within saphenous compartment in posterior calf parallel to sural nerves

small saphenous vein

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most common SSV termination

popliteal vein via saphenopopliteal junction

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cranial extension of SSV that communicates with GSV by terminating into posterior thigh circumflex vein

Vein of Giacomini

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described by its superficial-deep vein connections and its distances from anatomic landmarks

perforating vein

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embryologic remnants that course parallel to sciatic nerve in thigh
can function as a collateral pathway for the femoral vein
associated with Klippel-Trenaung syndrome

persistent sciatic veins

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primarily a test of venous reverse flow (reflux) detection

venous valvular insufficiency

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Function of lower extremity venous system

return blood from extermity back to heart and lungsW

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What affects Lower extremity venous flow?

distal pumping
proximal resistance
gravity

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Venous blood flow volume is affected by:

size and quantity of veins

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Veins have valves to make venous flow ______.

unidirectional

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3 types of disorders that affect lower extremity venous bicuspid valves

venous valve agenesis
venous valve damage
venous valve leakage

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most common finding in women with varicose veins but no significant edema

segmental reflux

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where segmental reflux starts

reflux source point

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where segmental reflux ends

reflux drainage point

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Over __% of population will develop CVI.

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reticular veins are also known as _____

spider veins

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ending of dilated little vessels

telangiectasias

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veins with diameters greater than 3 mm

varicose veins

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edema that affects fat tissue

lipedema

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most prevalent sign of significant phlebopathology

intermittent edema

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enlarged hypoechoic channels in thigh, lower leg, and foot

lymphatic obstruction

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determines a numerical quantitative index applicable or time-rated treatment related patient follow

clinical severity score

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relates daily activities to compressive therapy

disability score

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Focused on improving quality of life

quality of life questionnaire

two major diagnostic goals of Duplex sonography with CVVI

to exclude deep venous obstruction or acute thrombosis
evaluate the function of venous valves or reflux detection

identifies location of reflux source, channel, and drainage of veins

pretreatment assessment/ mapping

marks skin following veins, documents patency of deep venous system and efficacy of superficial venous ablation or eradication

peritreatment ultrasonography

Endovenous thermal ablation is done by ____ or ____.

radio frequency
laser energy

After thermal ablation, the treated vein segment gradually shrinks and sonographically disappears over ___ months.

6-9

formal term for sclerotherapy

chemical ablation

foamed or liquid chemical injected into vein

chemical ablation

The deep veins are evaluated in ______ position.

reverse Trendelenburg

The sonographer should evaluate superficially CVVI with patient _____.

standing

Antegrade flow is _____ and ____ the baseline.

toward the heart
below

Retrograde flow is ____ and ____ the baseline.

abnormal, reflux
above

Normal flow in vein proximal to compression _____ during compression and _____ during decompression.

increase
stop

_______ is dependent on vein filling with blood and vein emptying with compression.

reflux time duration

maneuver used to test valves above and below the knee

parana maneuver

Normal vein

smooth thin-walled with obvious change in venous diameter, fully compressible, hypoechoic lumen

enlarged veins
incompressible
echogenic material within lumen
thrombus that is soft and deformable

acute DVT

vein diameters that are diminitive in caliber, rigid and nondeformable material, may appear as fibrous strands or webs within lumen

chronic post thrombotic changes

increase in collateral vein diameters, veins are completely compressible, some valve sinuses may appear prominent with thickened valve leaflets, may eventually become tortuous varicose or even aneurysmal

CVVI

Normal venous waveforms

spontaneous
phasic with respiration
unidirectional toward the heart

partial obstruction causes _____ flow and a lack of flow augmentation.

continuous

arterial, venous, or fistula like flow causes

recanalization
neovascularization
inflammation

Reflux duration of saphenous vein valves

55 m/s

Reflux duration of deep femoropoliteal veins

less than 1sw

Reflux duration of perforating vein valves

less than 350 ms

transducer emits infrared light and detects signal reflected from blood within cuteaneous vessels

venous photoplethysmography

Normal FT

longer than 25 seconds

Normal venous FR

less than 2mL

Normal RV%

less than 20-35%

very low VV

calf venous thrombosis
chronic obstruction

high VV

abnormally high venous pooling because of larger or numerous veins

FT shorter than 10 seconds

severe reflux

FT shorter than 25 seconds

mild to moderate reflux

FR greater than 2 mL/s

venous insufficiency

RV% greater than 20-35%

increased ambulatory venous pressures

can show small superficial vessels upt o 1 cm in the skin; demonstrates subcuteaneous veins with a diameter or 0.5 to 2 mm

near-infrared imaging

______ is one of the most prevalent diseases.

CVVI

Within which of the following positions can a true saphenous vein be determined?
a. deep muscular fascia
b. subdural lipid layer
c. saphenous fascia
d. anterior vascular compartment

Which of the following is aligned with the deep system?
a. anterior accessory saphenous vein
b. great saphenous vein
c. posterior accessory saphenous vein
d. small saphenous vein

Into which of the following vessels does the small saphenous vein terminate?
a. popliteal vein
b. gastrocnemius vein
c. distal femoral vein
d. any of the above

What is the term for genetically absent venous valves that me complete or localized, creating reflux at any time under any conditions?

venous valve agenesis

What is an important factor that has correlation with reflux probability?

venous diameter

What are other causes of leg edema that may mimic venous obstruction or valvular insufficiency?
a. lymphatic obstruction
b. cardiac disorders
c. lipedema
d. all of the above

What is the area of phlebology that includes primarily visual signs of venous insufficiency?

aesthetic phlebology

A patient presents to the vascular lab with visible spider veins. Based on this information, what woul this patient’s clinical CEAP classification likely be?

A patient presents to the vascular lab with chronic bilateral leg swelling. Upon duplex assessment of the venous system, the deep system was found to be unremarkable, although a reflux was demonstrating in the bilateral great saphenous veins. What is the most likely CEAP classification for this patient?

C3EpAsPr

Before assessing the venous system for insufficiency/reflux, which of the following should be performed?
a. evaluation of the deep venous system for obstruction or thrombosis
b. evaluation of the arterial system for atherosclerotic development
c. mapping of the superficial venous system
d. auscultation for bruits in the lower extremitiies

To best demonstrate valvular incompetence, which position should the patient be examined in?

standing

When performing an examination for CVVI, patency and flow characteristics should be documented at all of the following locations EXCEPT:
a. common femoral vein
b. femoral vein
c. popliteal vein
d. anterior tibial vein

Which technique should be used to quantify reflux flow patterns?

spectral Doppler

Pathologic flow or reflux occurs during _____ of an automatic cuff when the cuff is distal to the site of insonation./

decompression

Which of the following describes the proper use of an automatic cuff compression device?
a. rapid inflation from 70 to 80 mm Hg of pressure, held for a few seconds and then released quickly
b. paced inflation from 70 to 80 mm Hg of pressure, then released quickly
c. rapid inflation from 120 to 150 mm Hg with immediate rapid deflation
d. gradual inflation and deflation of the cuff with the patient’s respiratory cycle

What is the major advantage of using hand compression instead of automatic cuff inflators?

adaptability to unusual venous segments

Which of the following is NOT a pitfall in measuring reflux?
a. high persistence resulting in false-positive color flow findings
b. high velocity scale or PRF setting affecting color flow sensitivity
c. low wall filter settings allow visualization of low-velocity venous flow
d. gain settings too high altering the sensitivity of spectral Doppler

After thermal ablation of a vein, what do the sonographic findings include?

potentially sonographically absent, fibrosed, or recanalized veins at different locations along the vein length

Valvular reflux time as measured on a spectral Doppler display are typically considered abnormal when greater than how many seconds?

What is the main purpose for venous photophlethysmography of the lower limb?

screening for detection of reflux

What can the use of a tourniquet during venous PPG testing help determine?

deep versus superficial vein reflux

A patient presents to the vascular laboratory for evaluation of valvular incompetence. A venous PPG examination is performed. The results of the examination demonstrate a venous refill time (VRT) of 10.5 seconds without the use of a tourniquet and 22 seconds with the use of a tourniquet. What do these findings demonstrate?

presence of superficial venous reflux

What is air plethysmography useful for?

quantification of chronic venous insufficiency

Using APG, increased ambulatory pressures suggestive of the inability to empty the calf veins owing to poor or nonfunctional calf muscle pump and indicated with which of the following?
a. residual volume greater than 20-35%
b. low venous volume
c. venous filling rate less than 2 mL/s
d. venous filling time greater than 25 seconds

Which of the following is an emerging technology that may help with guidance of venous access, phlebotomy, and injection sclerotherapy?
a. venous photoplethysmography
b. near-infrared imaging
c. air plethysmography
d. radio frequency imaging

Chronic venous insufficiency is a term used to describe venous insufficiency due to venous ______ or _______ insufficieny.

obstruction
chronic venous

Along with the great and small saphenous veins, the vascular technologist must also be familiar with the posterior and anterior ______ saphenous veins.

accessory

Saphenous veins are within a saphenous _____, readily identifying them on ultrasound. This structure gives the saphneous veins their distinctive ____ appearance.

compartment
fascia eye

The landmark to identify the anterior accessory saphenous vein is the ________, which is a vertical line perpendicular to the transducer surface that runs through the femoral artery and vein

alignment sign

Veins that pierce the saphenous fascia and drain into another major vein are known as _____ veins.

perforating

The triangle formed by the gastrocenemius muscle, the tibial bone, and great saphenous vein used to identify the GSV below the knee is known at the ______

angle sign

The tributary of the GSV near the saphenofemoral junction that is commonly used as a landmark for the venous ablation catheter is the _______ vein.

superficial epigastric

The confluence of the small saphenous vein and the deep venous system is _____, terminating into the popliteal vein, femoral vein, or other deep or perforating veins.

variable

Normal venous valves allow for _____ flow direction, whereas incompetent valves permit _______ flow or reflux.

antegrade
retrograde

Prevalence of venous reflux tends to increase with the severity of _________ and with increasing _____.

CEAP classification
age

Visual signs of abnormal venous pressures, such as spider veins or skin changes, are the primary basis for _____ classification.

CEAP

Temporary leg swelling at the end of a working day, after prolonged standing, or as result of leg positioning, may represent _____.

phleboedema

Cardiac disease, arterial disease, sympathetic tone, or lipid disorders are all differential diagnoses for _____.

edema

A skin change that results in a cluster of veins and skin changes, usually at the ankle, is ______.

coronal phlebactia

A patient with open skin ulcers, CVVI as major cause of clinical manifestations, and affecting superficial and perforating veins with a pathologic combination of pathophysiology would have a CEAP classification of _____.

C6EpAsPro

Duplex Doppler ultrasonography has two major diagnostic goals for CVVI: first is to rule out ______ and the second is the evaluation of ______ (reflux detection).

deep venous obstruction
valvular insufficiency

A concise duplex ultrasound evaluation designed for patients at risk or with a high probability of having CVVI is a ______ examiantion.

screening

An invasive diagnostic method to detect venous thrombosis, congenital venous malformations, or valvular function is _____.

venography

A CVVI treatment option that uses a foamed or liquid chemical agent injected directly into the vein is termed _____.

thermal ablation

Patient positioning for evaluation for venous disease typically starts with the patient in ______ position for evaluation of deep veins, whereas a _____ position is recommended for evaluation of CVVI.

reverse Trendelenburg
standing

If acute DVT is detected on initial assessment of a patient with suspected CVVI, the continuation of the CVVI is ______.

not recommended

When using proper compression techniques, abnormal veins proximal to the site of compression would demonstrate ______ flow during compression and ______ flow during decompression.

increased
retrograde

The most reproducible methods of compression include an automatic cuff and the “_____” maneuver

parana

Reflux time measurement should be performed with _____ Doppler with the vein in a sagittal image.

spectral

When performing a screening examination for CVVI, the scan can be interrupted after finding ____ level(s) of saphenous or nonsaphenous abnormality.

Evaluation of the femoropopliteal veins, deep calf veins, and entire superficial system (saphenous and nonsaphenous veins) would be appropriate in the ______ diagnosis of CVVI.

definitive

During thermal ablation treatment of CVVI, selection of incision site; insertion of needles, introducers, guide wires and catheters; and placement of tumescent anesthesia are all performed under ________.

ultrasound guidance

During postablation follow-up, the most important ultrasound documentation should be of the ____ veins to assure patency.

deep

To optimize detection of reflux, system settings, such as gain, scale/PRF, and persistence, should be adjusted to detect ______.

low flow states

In the diagnosis of CVVI, the measurement of reflux _____ is commonly preferred to measurement of peak reverse velocity or reflux volume flow rate.

time

In venous photoplethysmography, a PPG transducer is placed on the _____ aspect of the calf and venous _____ time is measured after the patient performs 5-10 foot flexion maneuvers.

medial
refill

Air plethysmography is a recommended technique for _______ of chronic venous insufficiency.

quanitification

In APG studies, patient performance of a series of maneuvers is _______ in obtaining reliable results.

paramount

A patient with a filling time (FT) of greater than 25 seconds, filling rate (FR) of less than 2 mL/s, and a residual volume (RV) of less than 20% would be considered ______ with respect to CVVI.

normal

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Chapter 20: Venous valvular insufficiency testing Flashcards

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