Module 4: Lower Leg Venous Flashcards
The lower leg exam starts with what?
Transverse compressions of the vein, as this is the gold standard for the exclusion of DVT
Compression images are to be captured using what?
Dual Screen function with the left side demonstrating the patent (open) vessel and the right side demonstrating the coaptation (compression) of the vein walls
All Settings, either 2D or Doppler are determined by what?
by the patient that you are scanning
The image taken above the confluence of the GSV in transverse is what?
Trans RT/LT CFV
What are some tips to get the Trans RT/ LT CFV?
- Keep the probe as perpendicular to the floor as possible
- Use medial pressure on the probe to compress the vein
- Make sure the vessel stays in the field of view
What is the acceptable annotation for the transverse GSV when we take the picture?
Trans RT/LT GSV
What are some tips to get the Trans RT/LT/ GSV?
- Take care not to slide off the GSV
- Light pressure is required to demonstrate the patency of the vessel.
What does the GSV dump into?
The CFV
What is the acceptable annotation for the transverse profunda picture?
Trans RT/LT PROF V
What are some tips to get the profunda?
- Angle slightly to the head to get more perpendicular
- the two arteries will not compress
What is another name for the profunda?
Deep femoral vein
What are the acceptable annotation for the Transverse proximal Femoral vein?
Trans RT/ LT FV PROX
What are some tips to getting the FV PROX 2D
- Use the best window available within range to demonstrate the anatomy
- Take just past the profunda anastomosis (typically)
- Remember to rock the probe to get perpendicular to the vein
What does the acceptable annotation for the transverse middle fv protocol?
TRANS RT/LT FV MID
What are some tips to find TRANS LT/RT FV MID
- Take this image when the probe is halfway between the inguinal crease and the knee
- You may also observe that this is the area just proximal to where the vein dives entering the adductor canal
What is the acceptable annotation for the transverse Femoral vein distal?
TRANS RT/LT FV DIST
What are some tips to finding the TRANS RT/LT FV DIST?
- take this image when the probe is just proximal to the medial condyle of the knee.
- Use either the anterior or posterior window
- Anterior window uses the muscle as a window to visualize the vessels
- Angling the probe slightly towards the patients head can help get perpendicular
What is the acceptable annotation for getting the transverse popliteal vein in 2D?
TRANS RT/ LT POP V
What are some tips to getting the transverse image of the popliteal?
- Place probe in the crease behind the knee (this will make the vein more superficial than the artery)
- Interrogate proximally to try overlapping the distal FV and distally to evaluate the tibial peroneal trunk
What is the acceptable annotation for a sagittal image of the common femoral vein?
SAG RT/ LT CFV
What are some tips to getting the sagittal common femoral vein?
- take the image above where the GSV dumps into the CFV
- The angle of the vessel will usually slope upwards from left to right on the screen.
- Angle the color box parallel to this
- Adjust the colour gain and scale accordingly
What is an acceptable annotation for getting a spectral image of the CFV?
SAG RT/LT CFV
What are some tips to getting the spectral image of the CFV? Is an augment required? What do we access for?
- All spectral image will use the same window as the colour image.
- An augmentation is not required
- access for direction, spontaneity and phasicity
What is an acceptable annotation for sagittal GSV colour image?
SAG RT/LT GSV
What are some tips in getting the SAG RT/LT GSV with colour? 2
- Slide the transducer medially while rotating counter- clockwise slightly
- pay attention to the colour scale as flow in the GSV is typically slower than the CFV
What is the acceptable annotation for the profunda vein with color?
RT/LT prof V
what are some tips to getting the profunda vein with color? 3
- Located approximately 2-3 cm distal to the GSV/ CFV confluence
- profunda vein should drop straight off the bottom of the CFV and course with the FA
- Find the blue pants
What is the acceptable annotation for the sagittal femoral vein proximal with color?
SAG RT/LT FV PROX
What are some tips to getting the sagittal femoral vein proximal with color? 3
- Taken a few cm from the profunda confluence
- Use the artery as a guide to ensure that you are on the vein
- blood filled artery acts as a window
What is the acceptable annotation for the sagittal femoral vein proximal spectral image?
SAG RT/LT FV PROX/ AUG
What are some tips to finding the sagittal femoral proximal spectral image?
- May need to reposition your body to perform proper augmentation of the vessel
- Augmentation should be shown after spontaneous, respirophasic flow and should alias
What is the acceptable annotation for a sagittal femoral vein middle colour image?
SAG RT/LT FV MID
What are some tips to finding the sagittal femoral vein middle color image?
- Take this image when the probe is halfway between the inguinal crease and the knee
What is the acceptable annotation for the sagittal femoral middle spectral image?
SAG RT/LT FV MID/AUG
What are some tips to finding the FV mid spectral? Augmentations should be shown to have what?
- May have to reposition your body to perform proper augmentation of the vessel
- Augmentations should be shown after spontaneous, respirophasic flow and should alias
What is the acceptable annotation for the sagittal distal femoral vein picture with color?
SAG RT/LT FV DIST
What are some tips to finding the sagittal femoral vein distal with color? What can we do in terms of pressure to get better doppler?
- take image immediately proximal to the medial condyle of the knee
- increased transducer pressure and using a more posterior window will give better color and spectral doppler
What is the acceptable annotation for a sagittal distal spectral image?
SAG RT/LT FV DIST/AUG
What are some tips in finding the sagittal femoral vein distal image with spectral?
- Understand that flow in the distal FV may be slower and require adjustments to the doppler scale and gain
- augmentations should be shown after spontaneous, respirophasic flow and should alias
What is the acceptable annotation for a sagittal popliteal image with color?
SAG RT/LT POP V
What are some tips to finding the sagittal popliteal image with color?
- Take image behind the knee noting the veins position superficial to the artery
- Pay attention to the color box angle as it should match the slope of the vessel
What is the acceptable annotation for the sagittal popliteal vein spectral?
SAG RT/LT POP V/AUG
What are some tips to find the sagittal popliteal vein with spectral?
- Augmentations should be shown after spontaneous, respirophasic flow and should alias
How many images are we taking with the lower leg protocol?
19 images
- Trans CFV
- Trans GSV
- Trans Profunda
- Trans FV Prox
- Trans FV mid
- Trans FV Distal
- Trans Popliteal Vein
- Sag CFV color
- Sag CFV Spectral
- Sag GSV color
- SAG Profunda vein color
- Sag FV prox color
- sag FV prox spectral
- Sag FV Mid color
- Sag FV mid Spectral
- Sag FV distal color
- sag FV distal Spectral
- Sag popliteal color
- Sag popliteal spectral
