Chapter 27- Misc Venous Testing/Treatment

Question 1

What is the main differences between ascending venography and descending venography?

Answer 1

Ascending is looking for acute DVT or Chronic DVT

Descending is looking for valv incompetency.

Question 2

Explain the process of ascending venography, including what were looking for and how it’s done?

Answer 2

Used to detect DVTs

Contrast is put into a vein on the dorsum of the foot, xrays are done to see the contrast pass through the veins to identify filling defects, collaterals, ect

Question 3

Explain the process of a descending venography, including what we are looking for and how it’s done.

Answer 3

Evaluate retrograde flow in incompetency.

Patient in UPRIGHT position, contrast is put in, and xrays are done to see if there is retrograde flow down the leg. Can determine location of reflux and incompetent valves.

Question 4

What is the best imaging we can do to identify a pulmonary embolus?

Answer 4

CT OF THE CHEST

Question 5

A patient is suspected to have valvular incompotency. Other than doing an US, what other imaging can we do?

Answer 5

Descending venography

Question 6

What are some ways we can promote venous drainage?

Answer 6

Elevate the legs, wear compressions, healthy weight, do calf compressions during extended bed rest

Question 7

A patient is suspected to have a DVT, other than an ultrasound, what other imaging can be done?

Answer 7

Ascending venography

Question 8

What are the 3 medications people with acute DVT or PE’s get put on?

Answer 8

Heparin, Coumadin, Eliquis

Question 9

What is the first of the three medications patient’s get put on with acute DVT?

Answer 9

First heparin for a few days, then coumadin (an oral med) for 3-6 months, then eliquis

Question 10

If a patient has EXTENSIVE DVT, or patients who cannot be safely anticoagulated, what is the next step?

Answer 10

IVC Filter

Question 11

What is the most common treatment for chronic insufficiency?

Answer 11

Ablation or destruction of these veins.

Question 12

Endovenous Thermal Ablation is used to get rid of incometent valves. Whats the process?

This usually includes the superficial trunks such as GSV, saphenous veins, SSV.

Answer 12

Use heat to scar to shrink and destroy the veins.

A catheter is put into the vein, anesthesia is injected to surround the vein, heat it up and take the catheter out.. We usually do a follow up in 2-7 days to make sure theres no DVT but that the vein worked on has been clotted.

Question 13

Ultrasound guided sclerotherapy is ??

Answer 13

a chemical ablation of incompetent valves, it is injected with chemicals that scars and destroys the vein.

Question 14

Sclerotherapy is often used on smaller veins such as?

Answer 14

Varicosities such as spider veins.

Question 15

What is the most common treatment for a patient with cirrhosis and portal hypertension?

Answer 15

TIPSS,

Question 16

The TIPS procedure involves making a shunt between what two veins?

Answer 16

Portal vein and right hepatic vein.

Question 17

If a patient came in with an acute DVT, what type of venography might be ordered?

Ascending or descending venography?

Answer 17

ASCENDING. That is used to detect acute and chronic DVT.

Question 18

What is the process of ascending venography?

Answer 18

Contrast injected into vein in the dorsum of foot watching for collateral devolopment or filling defects.

Question 19

If a patient has venous incompotence, which would the doctor possibly order?

Ascending OR Descending venography?

Answer 19

descending. This checks for venous incompotence.

Question 20

What is the process of descending venography?

Answer 20

contrast put into common femoral vein…xrays taken to see if flow retrogrades down the leg…therefore “Descending” venogrpahy makes sense.