Peripheral Venous Flashcards
since velocities are not measured no ______ ______ is needed
angle correction
what are you looking for with a peripheral venous evaluation
looking for thrombus (not stenosis)
__________ is the key
compression
deep venous thrombosis statistics…
1 to 2 per 1,000 in USA
1/3 of people with DVT/PE will have a recurrence within 10 yrs
60,000-100,000 die each year from DVT
carotid exam you are imaging _______ and in venous peripheral exam you are imaging ______
arteries
veins
peripheral venous eval’s are an ________ concern
emergent - emergency (need blood flow to the heart)
what is a DVT
deep vein thrombosis
vein wall is inflamed and thrombus is loosely attached
what is a DVT in approx the first 14 days
acute DVT
describe acute DVT
low echogenicity
distended vein
loss of compressibility
free floating thrombus
with acute DVT, new thrombus is _______ or _______ mass
hypoechoic or anechoic
with acute DVT, vein walls will not _______
compress
describe chronic DVT
more echogenic diffuse wall thickening scarred vein size of thrombus is reduced attached to the vein wall rigid
with chronic DVT, there are _______ and ______ vein protusions
hyperechoic and heterogeneous
lethal complication of acute DVT is _______ _______
pulmonary emboli (PE)
3 main goals of treating DVT are:
stop blood clot from getting bigger
prevent the blood clot from breaking off and moving to your lungs
reduce your chance of having another blood clot
what are 2 types of blood thinners used to treat DVT
warfarin or coumadin - pill form
heparin - injection or through IV tube
what will catch a blood clot
vena cava filter
risk factors of DVT
age post operative previous DVT immobility malignancy pelvic, hip, bone fractures pregnancy oral contraceptives trauma IV drug abuse heart disease
what is Virchow’s Triad
he did not use ultrasound
hypercoagulable state - blood will stick together
venous stasis - blood pools in the veins
vein wall injury
define hypercoagulable state
abn increased tendency toward blood clotting
define venous stasis
slow blood flow especially in legs
clinical findings of DVT
variable and unreliable asymptomatic tenderness/pain persistent leg or arm swelling edema
symptoms of DVT
pain
warmth
redness - erythema
swelling - edema
_____ leg symptoms are not associated with DVT
anterior
what is the Homan’s sign
forced plantar flexion of the ankle and may be POSITIVE for pain
shows DVT (+ Homan’s sign)
symptoms of acute DVT (emergency)
acute limb swelling recent onset pain local tenderness limb warmth shortness of breath (PE)
symptoms of insufficiency (boo-boo’s)
recurrent limb swelling varicose veins chronic leg heaviness statis dermatitis ulceration
describe superficial venous thrombosis
local erythema
tenderness/pain
palpable subcutaneous cord
describe varicose veins
superficial veins dilated elongated tortuous weakness of walls congenital
primary varicose veins are _______
congenital
describe PE
dyspnea (shortness of breath) chest pain hemoptysis - blood in sputum sweats cough
venous stasis will have _________ and _________ zone
ulcerations
gaitor zone - see image on slide 29
define veins
thin, echogenically homogeneous walls
peripheral veins return _________ blood back to heart
deoxygenated
venous systems of lower and upper extremities consist of _______, ______, and _______ veins
superficial
deep
perforating or communicating
perforating veins provide channels between ______ and ______ veins
superficial and deep
venous blood flow normally form _______ veins to _______ veins
superficial veins to deep veins
deep veins are the primary channels that transport blood from the ______ to the ______
extremity to the heart
deep veins are closely associated with the ___________ arteries
corresponding
name the deep veins
external iliac CFV SFV or FV DFV or Profunda POP
name the deep veins of the calf
PTV
peroneal
ATV
paired vessels that accompany the artery
define the valves
folds of the intima, innermost layer
bicuspid
more numerous in the distal leg
where are there NO valves
IVC
SVC
innominate or soleal
_______ drain the dorsum of the foot to form the popliteal vein
ATV - anterior tibial veins
______ originate from the planter veins of the foot and receive the peroneal veins before uniting with the anterior to form popliteal
PTV - posterior tibial veins
______ drains blood from the lower leg before they join the posterior tibial
peroneal
______ ______ are large venous reservoirs that empty into the posterior tibial or peroneal
soleal sinuses
__________ are paired and accompany an artery and terminate at the popliteal
gastrocnemius
_______ originates from the posterior and peroneal
popliteal
what is the hardest place to scan on the leg
IMPORTANT
hunter’s adductor canal
medial side of the knee
**distal thigh
SFV-FV are _____ veins and are buddies with the _____
deep
SFA
_____ or _____ unites with the SFV or FV to form the CFV
deep femoral or profunda
the CFV is part of _______ triangle
Scarpa’s
where your AO splits in the internal and external iliacs and this is called
Scarpa’s triangle
venous valves are found in the tunica ______
intima
allows flow to the heart
the left iliac vein can be compressed by the _____ _____ artery
right iliac
______ ______ vein lies in Scarpa’s triangle medial to the common femoral artery
common femoral
common femoral vein is formed by confluence of ______ ______ and ______ vein and also receives greater saphencous veins
profunda femoris
femoral vein
common femoral vein terminates at level of _______ _______ and becomes the ______ ______ vein
inguinal ligament
external iliac
what veins are part of the lower extremity-superficial
GSV
lesser saphenous vein
posterior arch vein
perforating veins
**used for bypass grafts
what is the longest vein in the body (lower extremity-superficial)
greater saphenous
what is the “stocking vein”
lesser saphenous joins the popliteal
perforating veins flow from ______ to ______
superficial to deep
the lower extremity deep veins tend to be ______
paired
describe paired peroneal veins
tibioperoneal trunk follo the arteries - venae comitnates
describe paired posterior tibial veins
tibioperoneal trunk
describe paired anterior tibial veins
join the tibioperoneal to form the popliteal
popliteal vein becomes the _______ vein at the ______ or ______ canal
femoral vein
adductor or Hunter’s
what should you do if the popliteal vein is hard to compress
use hand behind the knee technique
popliteal vein is the confluence of the _____ vein and _____/_____ vein — CFV
femoral vein
deep/profunda vein
_____ _____ vein - dorsum of the foot-groin
great saphenous
lesser or small saphenous vein joins the ______ vein
popliteal
reasons for upper extremity scanning
pain and swelling of arm or neck
palpable cord
dilated vein
indwelling catheter
upper extremity deep system consists of what
paired radial and ulnar drain the hand
upper extremity paired brachial veins are _____
deep
______ veins become subclavian vein. why is this difficult to compress
axillary vein
clavicle
what is the primary root of venous drainage in the upper extremity
the superficial system
______ vein begins on thumb side of hand
cephalic
_____ vein originates on the small finger side of hand
basilic
vessel walls ______ with light or moderate pressure by transducer on skin
collapse
phasic low-velocity doppler signals augment with ____ ____ compression
distal limb
common femoral vein change in size with _______
respiration
what is spontaneous flow
flow is present without augmentation maneuvers
describe pulsatile signals
should be present in jugular, subclavian, innominate, SVC because of retrograde transmission of right artrial pressure
describe respiratory phasicity
blood flow velocity changes with respiration
upper extremity - venous doppler signal will increase with inspiration and decrease with expiration
describe augmentation
blood flow velocity increases with distal limb compression or with release of proximal limb compression
**limited in upper extremity exams
what happens during respiration in general
diaphragm moves downward negative chest pressure venous return to heart increases venous flow in legs decreases abd pressure increases
in general what happens during expiration
diaphragm moves upward increasing chest pressure reduces venous return to the heart increases venous flow in legs abd pressure decreases
what transducer is used for venous dopplers
linear and vascular
12-5 MHz
how should the transducer approach the veins
perpendicular and do not tilt the transducer
angle correction is or is not needed
is not
what is not measured in a venous doppler
velocity
spectral doppler is used in long or transverse imaging
long
patients leg needs to lay in the ______ position
“frog” position
knee rolled out
what is reversed Trendelenberg
patient in supine with their feet higher than their head
transverse compressions should be done every ______ cm
2-4 cm
venous signal should be assessed for what 5 things
spontaneity phasisity non-pulsatility augmentation competence
what is the vein / artery position in the upper leg? how about the lower leg?
upper leg - artery on top, vein on bottom
lower leg - artery on bottom, vein on top
what are small veins located in the proximal calf by placing the transducer on the later calf in a transverse imaging plan
anterior tibial veins
where are the ATV located and how do they travel
located medial to the fibula in the proximal calf
travel with the anterior tibial artery
what veins are located near the medial malleolus and are followed proximally in the calf
posterior tibial veins
what veins are usually visualized as the transducer is moved a few cms proximally on the calf
peroneal veins
with doppler, the venous flow is heard and normal flow is characterized as ___________
spontaneity
doppler consists of what 4 characteristics
spontaneous - flow present
phasicity - changes with respiration
augmentation
pulsatile venous signal - jugular, subclavian, innominate, SVC
if doppler signal is abnormal and continuous the thrombus may lie closer to the _______
heart
5 characteristics of venous hemodynamics
spontaneous phasic with respiration augments with distal compression competency - no regurg with prox compression pulsatility - NOT
don’t mix these things with with a blood clot
enlarged lymph nodes
hematoma
baker’s cyst - found behind the knee
why are veins mapped
for path and diameter
**GSV & LSV
what is the purpose of superficial vein mapping
to determine the vein’s suitability for use as a bypass conduit and identify its anatomic route
vein mapping usually is performed before what operations
lower extremity arterial bypass or coronary bypass
describe venous reflux testing
identify the presence and the location on incompetent venous valves
performed with patient standing
valves are considered incompetent if retrograde blood flow is present and lasts greater then 1 second
patients with _____ clots are unlikely to have signs or symptoms of PE
calf
which vein comes off the common femoral vein first, greater saphenous vein or deep femoral vein
GSV branches off before the DFV/Profunda
