Chronic Venous Pathophysiology Flashcards
chronic post-thrombotic changes occur ___ to ____ after the initial event
months
years
the remaining material in a chronic clot is mainly _____
collagen
a chronic clot has _____ echogenicity and can be _____ to surrounding tissue
moderate to high
isoechoic
a DVT _____ as it ages, making the vein difficult to assess
retracts
when recanalization occurs, it can mimic a ______, which is called ______
partial thrombus
post-thrombotic scarring
Recanalization
the process of reopening a blocked or narrowed blood vessel, or restoring flow to a bodily tube
fibrous strands are not at a risk of ______
embolism
fibrous material creates a site that is predisposed to recurrent ______ DVT
acute
CVI
chronic venous insufficiency
CVI AKA
chronic venous disease
CVI can occur when a DVT results in _______ and can involve ______(4)
incompetent valves
superficial/deep veins, perforators, combo
in the chronic stage, thrombus can _______ over time
recanalize
permanent damage from chronic thrombus can leave the valve leaflets ____ and _____
immobile
fixed to the vein wall
there can also be permanent ______ where the vein retracts
occlusion
both recanalization and occlusion can lead to ______ and increased _____
chronic outflow obstruction
hydrostatic pressure
with dysfunctional valves there will be _____
reflux
if there is reflux due to dysfunctional valves, when standing there is a prolonged period of _______ blood in the leg
de-oxygenated
initial symptoms of CVI (4)
mild ankle swelling (edema) that resolves with limb elevation
heaviness/ache in lower limbs
telangiectasia
reticular veins dilated
telangiectasia
spider veins
4 symptoms of CVI as pressure increases and what they define
swelling/pitting edema
brawny discolouration/hyperpigmentation in gaiter zone
redness
varicose veins
define post-thrombotic syndrome
another name for redness
rubor
severe signs/symptoms of CVI
venous claudication
stasis dermatitis
ulcers
venous claudication
intense burning/cramping in calf with exercise
stasis dermatitis
inflammation of the skin (dry, flaky, red skin)
ulcers for CVI are normally seen around
medial malleolus
spider veins (size, colour, may have)
measure 1-1.5mm
pink/red/purple
may have pain/discomfort
reticular veins (size, colour, often has)
2mm in diameter
green-blue to purple
often has burning/itching
varicose veins (size, colour, often has)
larger than 2.5mm in diameter
dark blue/purple
veins often protrude above the surface of the skin and can lead to pain, burning and spasm
dysfunctional valves 2 types
primary
secondary
primary dysfunctional valves
congenital (absence, structural defects)
secondary dysfunctional valves
damaged from DVT
post-thrombotic syndrome
is reflux a primary or secondary effect
both
_____ (time) = normal amount of reflux
less than or equal to 0.5s
varicose veins are _____ veins
dialted
varicose veins are typically greater than ____ in diameter (but are considered varicose when above 2.5mm)
4mm
varicose veins examples (3)
GSV
SSV
subdermal veins
where are subdermal veins located
superficial to fascia
primary varicose veins involves the _____ system with no underlying _______ disease
superficial
deep venous
treatment for primary varicose veins
surgical ligation
ablation
surgical ligation
tie off vein
ablation
laser/radio F to heat + burn vein from inside
secondary varicose veins are due to (2)
obstructive conditions (previous DVT)
incompetent deep system
treatment for secondary varicose veins (2)
compression stockings
surgical ligation of perforators
does vein stripping resolve secondary varicose veins
no
the role of US assessing CVI (4)
- rule out DVT
- assess deep system (phasicity/reflux)
- assess superficial for reflux (GSV/SSV)
- assess perforators
assessing the deep system patient position
standing on platform with a handrail, leg externally rotated, weight transferred of of leg scanned
if patient can’t stand on one leg to assess the deep system how do you position them
lying with extreme reverse trendelenberg
sitting with legs dangling over the side of the bed for calf veins
assessing deep system 3 steps and what veins for each step
vein compression/phascicity (CFV, prox FV, Pop V)
Valsalva maneuver (reflux in CFV/Prox FV)
augmentation (Pop V)
for deep system Valsalva maneuver in CFV/prox FV, ____ of reflux is abnormal
> 1s
when measuring GSV diameter, ____ at SFJ, ____ at mid-thigh, and ____ a calf is highly predictive of incompetence
> 9mm
7mm
5mm
for superficial veins, use Doppler with Valsalva ____ and augmentation ___ to look for reflux
proximally
distally
for sup veins, reflux times _____ = abnormal
> 0.5s
assess the GSC from ____ to ____, between teh ____ and ____ planes, and look for ______ veins
SFJ
ankle
superficial
deep
accessory
SFJ
saphenofemoral junction
assess the SSV from ____ to ____ and you may continue to the _____ vein
mid calf
pop v
Giacomini
the SSV is found between the 2 bellies of the _________ muscle
gastrocnemius
SSV usually measures _____ AP
<2mm
assess SSV with _____ and _____. _____ to look for reflux (_____ = abnormal)
colour
spectral
augment
>0.5s
what is the most commonly visualized perforator and where
Cockett’s (medial calf)
scan cockett’s in the ____ plane from the ____ to the _____
trans
tibial condyle
medial malleolus
when assessing the perforators you scan the ______ of the calf
circumference
abnormal perforators will show _____ with augmentation
bi-directional flow
if perforators are abnormal with colour, perform ____ and measure _____
spectral
reflux time
perforators are best assessed with ____ Doppler
colour
abnormal reflux times:
deep:
sup:
perf:
> 1s
0.5s
0.35s
endovenous thermal ablation (what/2 benefits)
laser/high F RF creates intense heat that collapses veins/seals it shut
less pain/faster healing time than surgical
sclerotherapy (what/3 benefits)
solution injected into spider veins or small varicose veins to cause them to collapse or disappear
can reduce pain/discomfort
improves appearance
cost effective
US role in endovenous thermal ablation (3 before, 2 after)
rule out DVT/map veins for treatment
diameters assessed to ensure suitability
access points determined
during to oversee access site/introduction of catheter
follow up to see if successful
2 surgical treatments
ligation/stripping
vein bypass
ligation/stripping
ligation = cutting/tying off
stripping = removes vein through 2 small incisions
vein bypass
healthy vein used to reroute blood around the problem vein
CABG
coronary artery bypass graft
venous mapping
duplexUS is used to asses sup veins for use as a bypass conduits (arterial conduit)
venous mapping 2 types
CABG
lower extremitiy grafts
what is the first choice for venous mapping
GSV
diameter of GSV
> 2.5cm
US is used to prove ____ for venous mapping
patency of the vessel
CW can also be used to determine the ____ and _____ of reflux
presence
origion
CW has no image so it can make it difficult to know of lack of flow is due to ____ or ____
DVT
extrinsic compression
CW evaluates the ____ and ____. First in the _____ and compared to signal after _____
waveform
auditory signals
resting position
provocative maneuver
