Chapter 21: Sonography in the Venous Treatment Room Flashcards
a long-lasting valvular or obstructive disorder of the veins
chronic venous insufficiency
destruction of the vein by various means
endovenous ablation
anesthesia that placed around the vein to be treated with thermal ablation under ultrasound guidance
perivenous (tumescent) anesthesia
physician who is specialized in the diagnosis and treatment of vein disorders
phlebologist
retrograde flow upon release of distal compression in standing patient
Greater than 0.5 seconds in the superficial venous system
Greater than 1.0 second in deep venous system
reflux
a chemical irritant used in the treatment of varicose veins, resulting in inflammation and subsequent fibrosis, thus obliterating the lumen of the vein
sclerosant
a medical procedure involving an injection of a sclerosant into the vein; may be performed visually or under ultrasound guidance.
sclerotherapy
Gold standard method for assessment of veins
Duplex ultrasound
What is the overall goal of venous ultrasound studies?
assess venous system hemodynamics
Traditional way to treat CVJ and specifically superficial venous disease
Vein stripping and ligation
Surgical removal/ destruction of veins. Typically performed on the inside of veins
Ablation
surgical procedure in which a small incision is created next to the varicosity and a special instrument is employed to hook the vein and extract it
ambulator phlebectomy/microphlebectomy
a sonographer who has thorough knowledge of venous anatomy and hemodynamics
Registered Phlebology Sonographer
physician who is specialized in the diagnosis and treatment of venous disorders
phlebologist
first assistant in interventional room
sonographer
Complications of misplacing endovenous thermal device
ablation of EIV and CFV
Complications of misplacing chemical sclerosant into popliteal artery
loss of limnb
primary role of sonographer in interventional room
provide ultrasound guidance
For a microphlebectomy or vein extraction, the patient should remain standing for ____ minutes to ensure maximum distention of any superficial veins
5-10
Patient position for GSV or AAGSV ablation
supine, head slightly elevated, leg externally rotated, knee slightly bent
Patient position for SSV ablation
prone, pillow under feet
The tumescent anesthesia needle is __ cm long
10
Why is it important to evaluate for presence of any large tributaries or perforating veins?
increased risk of incomplete ablation or subsequent recanalization at the point where vessels intersect
Notable thickened wall veins when mapping veins can be from _____.
vasospasm
What is “flash”
blood return in syringe
Failure to position device properly can result in:
endovenous heat-induced thrombosis
deep vein thrombosis
thermal ablation of deep vein itself
A patient should have a follow up ultrasound ____ postprocedure
2-7
The goal of ________ is to distribute sclerosant volume to diseased vein(s)
ultrasound guided sclerotherapy
Which of the following are reasons why traditional surgical stripping and high ligation are rarely performed?
a. invasive and painful procedure
b. requires general anesthesia
c. prolonged recovery requiring weeks to months
d. all of the above
d
What is the surgical procedure in which a small incision is created next to a varicosity and a spectral instrument is used to hook and extract the vein?
ambulatory phlebectomy
Which of the following is a credential that can be earned to demonstrate a thorough knowledge of venous anatomy and hemodynamics?
a. ARNP
b. RPhS
c. RCS
d. RVT
b
What is the primary role of the sonographer in the intervention room during venous treatment?
provide ultrasound guidance
Which of the following would be a critical step in preparing the patient for a venous treatment procedure?
a. documenting the patient’s clinical condition
b. verifying the correct leg and vein to be treated
c. scheduling a postoperative appointment
d. explaining the venous disease process
b
When the small saphenous vein is being treated, what is the most common patient position used to ensure access to this vein?
prone
Because of the location of most of the veins that will be evaluated in the intervention room, what are the typical transducer frequencies that will be used?
high frequency
While providing ultrasound guidance, what is indicated by a vein that has a notably thickened wall and a reduced lumen diameter?
vasospasm
What is the advantage of viewing the access needle in a longitudinal plane rather than transverse?
needle can be more easily advanced directly under the transducer
What is the term for blood that is returned through the needle when assessing a vein?
flash
Where should the guidewire be located?
intraluminally in the vein to be treated
What landmark should be used to ensure the tip of the treatment device is positioned appropriately in the great saphenous vein?
superficial epigastric vein
Which structure is near the saphenopopliteal junction and can be injured by the treatment device?
sciatic nerve
One the treatment device is in place, what position should the patient be placed in before treatment begins, ensure the veins empty and contract around the device.
Trendelenburg
Which imaging plane is typically preferred for guidance of placement of tumescent anesthesia?
longitudinal
After placing the tumescent anesthesia, what is the minimum separation between the treated vein and the skin line?
1-2 cm
What would a hyperechoic echo actively forming as the thermal ablation device is being withdrawn represent?
destruction of endothelial lining
When should initial follow up occur after a patient has had a thermal ablation?
2 to 7 days postprocedure
Which of the following is typically applied to the patient’s leg postablation procedure?
a. small bandages over incision sites and graduated compression stockings
b. small bandages over incision sites and nothing else
c. soft; supportive cast
d. absorbent pads and bandages over incision sites
a
The invasive, surgical, traditional treatment of chronic venous insufficiency is known as vein ______
stripping and high ligation
Current minimally invasive techniques for treatment of chronic venous insufficiency are largely performed under ultrasound ______ in order to place needles, devices, and drugs.
guidance
Treatment of bulbous tributaries, smaller varicosities, reticular veins, and telangiectasis typically involves _______ ablation.
endovenous thermal or chemical
A complication that may result during thermal ablation or administration of perivenous anesthesia because of a needle piercing both an artery and a vein is a(n) ______
arteriovenous fistula
If a patient is scheduled for micro-phlebectomy, it is recommended that they remain standing for _____ minutes to ensure maximum distention of superficial veins.
5-10
While in the intervention room, ultrasound evaluation is primarily a(n) ______ process.
imaging
In preparation for an ablation procedure, many centers will _____ the vein to be treated so that it can be easily identified and followed.
mark
A patient who is cold, dehydrated, or apprehensive about the interventional procedures may have veins that are in _____.
vasospasm
To maintain a sterile field during an ultrasound-guided procedure in the intervention room, the ultrasound transducer is place in a(n) ______.
sterile sheath
When gaining access to the vein for treatment, it is preferable to access below any larger _______ or isolate their connection with truncal veins.
tributaries
To help induce vasodillatation, heat or _______ can be applied.
micropaster
A difference between thermal ablation and adhesive ablation is that with adhesive ablation, transducer or manual ______ must be applied to collapse the vein in order to limit proximal progression of the adhesive.
compression
Encountering a valve or small tortuosity can cause ______ when advancing the catheter or treatment fiber.
resistance
When treating the small saphenous vein, the treatment device should not be advanced out of the _____.
small saphenous compartment
On the ultrasound image, the tumescent anesthesia appears as a(n) ________ “cocoon” of fluid encircling the vein.
hypoechoic
If the thermal ablation catheter is too close to the skin line, superficial _______ can occur and be permanent.
skin burns
Pressure should be applied over a thermal ablation device to ensure that the vessel walls are _____ and in contact with the device.
coapted
Particulary large venous segments or connections with large tributaries warrant additional _____ and increased transducer pressure to ensure adequate closure.
energy
To ensure a sclerosing agent completely fills the varicosities, the ______ from the cluster of treated vessels should be identifited.
primary outflow
Adequate dispersion of a sclerosant can be accomplished by applying pressure or “_____” the tissues to move the sclerosant in the desired direction.
milking
