Chapter 28 Flashcards by Solo Ustimov

what are capabilities with peripheral vein duplex imaging?

identify venous thorbosis (acute vs chronic)
evaluate non - occluding /partial thrombus
detect calf lesion
distinguish between extrinsic compresion and intriscic obstruction
evaluate soft tissue masses
detect venous incompetence
document recanalized channels or collateralization

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what are capabilites with abdominal / pelvic veins with duplex imaging?

assist with documenting elevate systemic venous pressur eidentify venous throbosis
evaluate patency of IVC interruption devices
assess portocaval shunts
evaluate of some liver diseases

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what are limits of visulation in duplex imaging?.

edema, scarring, recent surgery, obesity

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what are some sources of false positive?

extrinsic compression e.g tumores, ascites, pregnancy
PAD- decreased venous filling
chronic obstructive pulmonary disease- elevated central venous P
improper doppler angle or probe pressure
SVC syndrome

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what are sources of false negative studies?

proximal obstruction

techneq limited studies

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why may it be diff to evaluate infra-pop v

secondary to vessel size, depth and course

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why may it be diff to evaluate sub and brachiocephalic. innominate veins

due to bony structures

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why is it hard to evaluate abdominal veins

vessel depth and presence of bowel gas

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what is patient positioning for lower extremity peripheral veins exams

faciliate venous filling ie reversed trendelenburg
diminish extrntiric compression e.g extreme LLD
for reflux testing: when the patient is standing, and bears weight on contralateral leg

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what is patient positioning for upper extremity peripheral veins exams

supine or low folwers position

arm in pledge position

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what is patient positioning for abdominal veins

supine with head slightly elevated
LLD with head of bed elevated slightly
reversed trendenburg
or whatever works

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how do you maximize color fillings and flow patterns?

adjust color scale to detect slower velocities
change wall filters
increase color gains

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what is another word for compressibility

coaptation

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what should venous flow patterns look like

spontaneous
phasic
aug with distal compresision
aug with prox release /valsa

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how is the CFV formed?

confluence of femoral and DFV

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where should you begin scanning the CFV?

at the inguinal ligament
identify the CFA
should be free of thrombus
in trv should assess for complete compressbiliby of vein walls

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T/F thrombosis of superfical system at or near deep system requires more aggressive treatment

true

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what is the sapehnofemoral junction

where GSV joins CFV

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what is formed from the confluence of FV and DFV

CFV

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T/F at the distal third of thigh it may be difficult to compress the vein

true

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what forms the pop v

confluence of anterior tibial vein and tibio-peroneal trunk

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what other things should you evaluate near the pop fossa

any cystic structures or masses, ie bakers cyst
muscular/gastro veins 
LSV 
veins of trifurcation
ATA

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where should the probe be to evaluate the PTVS

between medial malleolus and achilles tendon

evaluate vessels along medial surface of calf

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where does the ptv terminate

in tibio-peroneal trunk near the pop fossa

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what is the location of peron v

evident a few cm prox to the malleolus deeper than ptv evaluate vessel along medial calf (with ptvs)

where does the peron v terminate

tibio-peroenal trunk

what is chronic venous insufficiency?

flow reversal, usually in repsonse to a vala maneuver or during prox manual compressions, indicates venous reflus

what are method to identify reflux

spectral analysis: reversed venous flow lasting more than 1 second noted during prox compression manauever color flow imaging: color changes noted during prox compression maneuver

where can blood pressure cuffs be applied for reflux

applied distal to the transducer

where will the IJv be

near CCA in neck evaluate from mandible to where it joins subclav vein transverse vein to evaluate compressibility

how is the subclav vein formed?

cephalic and axillary veins joins with IJV to form innominate vein bilaterally evalued from supraclavicular approach can usually be followed only to outer border of first rib (clavicle prevents further vis) infraclavicular approach may be used to eval distal segment

axillary vein

formed by confluence of the baslic and brachial v | evaluated with arm raised ie pledge position, and probe in axilla

brach vein

formed by raidal and ulnar veins | location varies considreably from antecubital fossa to axilla

radial and ulnar veins

formed by confluence of palmar arch veins

where does the IVC and pelvic veins evaluation begins

at level of umbilicus

where does other views of abdominal vessels begins?

trans view at xiphoid process

where would you hear spontaneity of the veins

at all sites except PTVs

what is phasicity

sound varies with repirations

what happens to the phasicity lower extremities

increases with expiration and decreases with inspiration

what happens to the phasicity upper extremities

decreases with expiration and increases with inspiration

when will augmentation occur

with distal compression or proximal release

what does augmentation with valva mean

reflux/ retrograde flow

what is extrinisic compression

pressure on vessels from surrounding tissues and/or structure can cause abnormal patterns

when will pulsatile venous flow pattern be evident

with fluid overload or CHF

what may help compress a upper extrem vein that is hard to compress due to bony structures

a quick breath though pursed lips should collapse vein

which veins may have pulsitile waveforms

subclav and innominate veins | aug with distal compress may not be evident

which vessels will have phasic, bidirection/pulsatile doppler signals

IVC renal and hepatic

what vessels will have minimally phasic, continuous doppler singal

portal, splenic and mesenteric veins

what flow patterns will abd and pelvic veins have

dilatation with deep inspiration | spontaneous doppler signals

T/F during inspiration there is minimal flow fluctuation in the portal vein, flow is variable in the hepatic vein

true

what will happen with acute thrombosis

peripehral veins not compeltely compressible being filled with very low level echoes visible thrombus may be evident vessel is dilated abnormal doppler signals

if flow is not spontaneous at the CFV, FV, or Pop V an obstruction is where

distal to or at that site is suggested | may indicate a DVT or extrinisic compression

if flow is not phasic but continuous where is the obstruction

proximal

if no augmentation with distal compression is seen where is the obstruction

between where you are compressing and where you are listening. or slighly mor eproximally

if there is no aug with proximal release, where is the obstruction

proximal

if flow increases during proximal compression what does it signify

reflux

what is rouleau formation?

very sluggish flow seen as heterogeneous material moving with respirations and aug manuevers red blood cells arranged like rolls of coins or rouleau

a compressible vessel with evidence of rouleu formation on B mode, could mean what

normal or suggest proximal oBstruction eg Dvt, increased central venous pressure, svc syndrome

what are chronic changes to a vein

highly echogenic visible collateraliztion or recanalization may be evident vessel not dilated may retract over time abnormal doppler venous signal may be evident eg continuous decrease phasicity, or no aug) venous reflux lasting >0.5 or >1sec

how will reflux look on color doppler

as a shift in color from flow away from probe to flow towards probe during the valsalva man and or following compression distal to the transducer

where are IVC interruption devices placed

below renal veins and may appear as bright echogenic lines

what will happen with systemic venous HTN

persistent dilated vessels evident

what will happen with portal HTN

increased portal venous pressure can result in variety of flow alterations reversed flow in portal vein hepatfugal collateral development

what is budd chiari syndrome

results from hepatic vein occlusion | primary site of obstruction may be hepatic vein, sinusoid, or ivc

what are clinical findings with budd chiari

hepatomegaly, abdominal pain, sudden onset of ascites

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Chapter 28 Flashcards

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