Duplex US Imaging of the Lower Extremity Venous System (Lecture 6)

Question 1

What is the purpose of Superficial Veins?

Answer 1

Regulate body temperature

Question 2

What is the role of perforators?

Answer 2

Move blood from the superficial veins to the deep veins

Question 3

What is Virchow’s Triad?

Answer 3

Venous stasis, hypercoaguability, vessel wall injury

Question 4

Where do DVTs commonly begin?

Answer 4

Soleal sinus vein

Question 5

What are other risk factors for VTE?
COIT OFO

Answer 5

Cancer
Obesity
Immobility
Trauma/Surgery
Hormones or pregnancy
Factor V Leiden
Other thrombophilia

Question 6

What are the signs and symptoms of venous thromboembolism?

Answer 6

Venous obstruction, inflammation, and embolization of thrombi

Question 7

What are symptoms consistent with PE that a patient may show during a VTE?

Answer 7

Tachypnea, chest pain, tachycardia

Question 8

A negative d-dimer is a low or high specific test?

Answer 8

Very highly specific

Question 9

What is a D-Dimer?

Answer 9

Breakdown product of fibrin which will be elevated in the presence of DVT

Question 10

What is the termination of the GSV into the CFV called?

Answer 10

Saphenofemoral junction

Question 11

The terminus of the Small Saphenous Vein into the Popliteal Vein is known as which junction?

Answer 11

Saphenopopliteal Junction

Question 12

What is a Giacomini vein?

Answer 12

When the SSV bypasses the popliteal vein and continues up the posterior thigh

Question 13

What is the one of the major storage areas for blood in the calf?

Answer 13

Soleal sinus vein

Question 14

When would you image above the groin for a lower extremity DVT scan?

Answer 14

Unless there is clinical indication to suggest involvement of the iliac veins or the IVC

Question 15

What 5 characteristics should Venous Doppler signals display?

PPAPU

Answer 15

1. Present Spontanous Doppler signals within all major vessels
2. Phasic with respiration
3. Augmented flow with compression
4. Promixal compression should never cease the signal
5. Unidirectional towards the heart

Question 16

If you have a thrombosed vein, what should your doppler look like?

Answer 16

Colour flow and spectral waveforms will be absent, imcompressible vein

Question 17

If you have a distal thrombosis, what should your doppler look like?

Answer 17

Vein is compressible but when doing distal compression, no colour flow is observed or no augmentation appears in spectral

Question 18

If you have a proximal thrombosis, what should your doppler look like?

Answer 18

Vein compresses but lacks respiratory phasicity and does not cease with proximal compression or valsalva (called continuous flow) - basically just looks like continous fuzz below baseline

Question 19

Arteriovenous fistulae can be associated with what kind of flow?

Answer 19

Unilateral pulsatile venous flow

Question 20

What type of flow in LEV is abnormal?

Answer 20

Retrograde flow

Question 21

What is May-Thurner syndrome?

Answer 21

Compression of the left common iliac vein by the right common iliac artery

Question 22

What is Phlegmasia alba dolens?

Answer 22

Milk leg, marked swelling of lower extremity, pain, pitting edema, blanching - but no ischemia present

Question 23

What is Phelegmasia cerulean dolens?

Answer 23

Massive swelling and cyanosis, severe pain

Question 24

What are nonvascular findings of a DVT study?

Answer 24

Hematomas, cysts, edema, abscesses, enlarged lymph nodes, and tumours

Question 25

What can rupture behind the knee and appear as a fluid collection that dissects along the fascial planes in the calf?

Answer 25

Pop fossa cyst (Baker’s cyst)

Question 26

What are some vascular findings during a DVT study?

Answer 26

Aneurysm, pseudoaneurysms, arteriovenous fistulas, or significant arterial disease

Question 27

What is the primary treatment of DVTs?

Answer 27

Anticoagulation medication