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Internevtional > EHIT/GHIT > Flashcards

EHIT/GHIT Flashcards

1
Q

venous insucciciency treatment deep vein?

  • invasive
  • non-invasive
A

invasive:
- surgical valve repair or replacement

non-invasive:

  • ecercise
  • compression stockings
  • leg elevation
  • medications
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2
Q

venous insufficiency treatment superficial veins- invasive?

A
  • surgical vein ligation and stripping
  • hospital stay
  • long painful recovery
  • significant scarring
  • mortality
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3
Q

venous insufficiency superficial veins- minimally invasive (thermal)?

A
  1. radiofrequency ablation (RFA)
  2. closure fast
  3. endovenous laser therapy (EVLT)
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4
Q

venous insufficiency superficial veins- minimally invasive (non-thermal)?

A
  1. cyanoacrylate closure (CAC)
  2. venaseal
  3. adjunctive treatment
    - sclerotherapy
    - ambulatory phlebectomy
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5
Q

what is RFA?

A
  • Thermal
  • Newer technology
  • Heat is delivered to the vein wall, causing the vein to shrink and close
  • Outpatient procedure
  • Resume normal activity same day
  • 92% closure rate at 5 years
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6
Q

RFA procudure?

A
  • Small incision is made into the skin to gain venous access
  • Under Ultrasound guidance a catheter is inserted into the refluxing vein
  • The catheter tip is positioned 3cm from the SFJ / SPJ
  • Tumescent anesthetic is administered
  • The catheter tip position is confirmed with Ultrasound
  • The vein is then heated in segments of 3 or 7cm at 20 second intervals
  • Transducer compression is applied at each segment
  • Catheter is removed
  • Steri – Strip and compression stockings are applied
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7
Q

what is EVLT?

A
  • Thermal
  • Heat is delivered through a laser fiber causing damage to the vein, scar tissue to form, closing the vessel
  • Outpatient procedure
  • Resume normal activity same day
  • 98% closure rate
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8
Q

EVLT procedure?

A
  • Small incision is made into the skin to gain venous access
  • Laser fiber is inserted
  • The laser tip is located with Ultrasound and pulled back 3cm from the SFJ / SPJ
  • Tumescent anesthetic is administered
  • The laser tip position is confirmed with Ultrasound
  • The heated laser fiber is pulled back very slowly and continuously while applying transducer compression
  • Fiber is removed
  • Steri-Strip bandage and compression stockings applied
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9
Q

what is CAC?

A
  • Non-Thermal
  • Delivers a small amount of medical adhesive to seal the refluxing vein
  • Immediate vein closure
  • Outpatient procedure
  • Resume normal activity same day
  • 95% closure rate at 5 years
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10
Q

CAC prodecure?

A
  • Catheter inserted into the refluxing vein through a small puncture
  • Under Ultrasound guidance the catheter is placed 5cm from the SFJ / SPJ
  • Adhesive is placed in the refluxing vein, one segment at a time
  • Transducer compression is applied during the procedure to help seal vein segment
  • Catheter is removed
  • Steri-Strip bandage is applied
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11
Q

complications of EVLT and RFA?

A 
Pain / Discomfort
Bruising
Nerve irritation
Skin burns 
Skin discoloration
Infection
Phlebitis 
Endovenous Heat Induced Thrombosis (E-HIT)
PULMONARY EMBOLISM
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12
Q

CAC complications?

A
  • Pain / Discomfort
  • Bruising
  • Hypersensitivity to glue
  • Infection
  • Phlebitis
  • Endovenous Glue Induced Thrombosis (E-GIT)
  • PULMONARY EMBOLISM
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13
Q

venous indufficiency treatment thermal vs. non-thermal?

A

thermal:
- endovenous head induced thrombosis (E-HIT)

non-thermal:
- endovenous glue induced thrombosis (E-GIT)

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14
Q

reported rated of E-HIT ranges from?

A

0-3%

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15
Q

3 classifications for E-HIT?

A

Kabnick et al.
Lawrence et al.
Harlander - Locke

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16
Q

Kabnick classification?

A

First introduced the term Endovenous – Heat Induced Thrombosis in 2006
Most recognized and widely used
Used specifically for SFJ and SPJ

17
Q

kabnick classification ( class 1-4)?

A
  1. thrombus extended up to and including deep vein junction
  2. thrombus propagation into adjacent deep vein but comprising <50% of deep vein lumen
  3. thrombus propagation into adjacent deep vein but comprising >50% of deep vein lumen
  4. occlusive deep vein thrombus contiguous with the treated superficial vein
18
Q

Lawrence classification class 1-6?

A
19
Q

harlander- locke classification A-D?

A
20
Q

E-GIT classifications?

A
  • CAC relatively new procedure
  • classifications are unclear
  • many facilities adhering to kabnick classification
21
Q

role of U/S during procedure?

A
  • U/S typically ordered anywhere from 24 hrs to 2 weeks status post RFA, EVLT, CAC
  • Determine the success of the closure
  • Identify thrombus extension into the deep veins (E-HIT / E-GIT)
  • Locate the presence of open tributaries
  • Neovascularity
  • Monitor mild cases of reflux in other vessels
21
Q

role of U/S during procedure?

A
  • U/S typically ordered anywhere from 24 hrs to 2 weeks status post RFA, EVLT, CAC
  • Determine the success of the closure
  • Identify thrombus extension into the deep veins (E-HIT / E-GIT)
  • Locate the presence of open tributaries
  • Neovascularity
  • Monitor mild cases of reflux in other vessels
22
Q

if E-HIT or E-GIT is identifies the sonographer will document what?

A
  • Sagittal and Transverse 2-D, Color and Spectral Doppler images at the level of thrombus
  • Measure the length of the thrombus into the junction
  • Cross sectional diameter measurement
  • Immediately report findings to the Physician in order to facilitate a plan for treatment, as indicated
23
Q

Kabnick Classification treatment?

A

Class I : No treatment
Class II : Low molecular weight heparin until resolution of the thrombus, with Ultrasound follow up
Class III : Low molecular weight heparin and vitamin k antagonist for a minimum of 3 months, with Ultrasound follow up
Class IV : Low molecular weight heparin and vitamin k antagonist for a minimum of 3 months, with Ultrasound follow up

Internevtional (12 decks)

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