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Summer 2014 - Intro to Vascular ✔️ > Peripheral Venous > Flashcards

Peripheral Venous Flashcards

0
Q

since velocities are not measured no ______ ______ is needed

A

angle correction

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1
Q

what are you looking for with a peripheral venous evaluation

A

looking for thrombus (not stenosis)

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2
Q

__________ is the key

A

compression

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3
Q

deep venous thrombosis statistics…

A

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

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4
Q

carotid exam you are imaging _______ and in venous peripheral exam you are imaging ______

A

arteries

veins

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5
Q

peripheral venous eval’s are an ________ concern

A

emergent - emergency (need blood flow to the heart)

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6
Q

what is a DVT

A

deep vein thrombosis

vein wall is inflamed and thrombus is loosely attached

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7
Q

what is a DVT in approx the first 14 days

A

acute DVT

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8
Q

describe acute DVT

A

low echogenicity
distended vein
loss of compressibility
free floating thrombus

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9
Q

with acute DVT, new thrombus is _______ or _______ mass

A

hypoechoic or anechoic

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10
Q

with acute DVT, vein walls will not _______

A

compress

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11
Q

describe chronic DVT

A 
more echogenic
diffuse wall thickening
scarred vein
size of thrombus is reduced
attached to the vein wall
rigid
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12
Q

with chronic DVT, there are _______ and ______ vein protusions

A

hyperechoic and heterogeneous

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13
Q

lethal complication of acute DVT is _______ _______

A

pulmonary emboli (PE)

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14
Q

3 main goals of treating DVT are:

A

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

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15
Q

what are 2 types of blood thinners used to treat DVT

A

warfarin or coumadin - pill form

heparin - injection or through IV tube

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16
Q

what will catch a blood clot

A

vena cava filter

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17
Q

risk factors of DVT

A 
age
post operative
previous DVT
immobility
malignancy
pelvic, hip, bone fractures
pregnancy
oral contraceptives
trauma
IV drug abuse
heart disease
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18
Q

what is Virchow’s Triad

he did not use ultrasound

A

hypercoagulable state - blood will stick together
venous stasis - blood pools in the veins
vein wall injury

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19
Q

define hypercoagulable state

A

abn increased tendency toward blood clotting

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20
Q

define venous stasis

A

slow blood flow especially in legs

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21
Q

clinical findings of DVT

A 
variable and unreliable
asymptomatic
tenderness/pain
persistent leg or arm swelling
edema
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22
Q

symptoms of DVT

A

pain
warmth
redness - erythema
swelling - edema

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23
Q

_____ leg symptoms are not associated with DVT

A

anterior

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24
Q

what is the Homan’s sign

A

forced plantar flexion of the ankle and may be POSITIVE for pain

shows DVT (+ Homan’s sign)

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25
Q

symptoms of acute DVT (emergency)

A 
acute limb swelling
recent onset pain
local tenderness
limb warmth
shortness of breath (PE)
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26
Q

symptoms of insufficiency (boo-boo’s)

A 
recurrent limb swelling
varicose veins
chronic leg heaviness
statis dermatitis
ulceration
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27
Q

describe superficial venous thrombosis

A

local erythema
tenderness/pain
palpable subcutaneous cord

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28
Q

describe varicose veins

A 
superficial veins
dilated
elongated
tortuous
weakness of walls
congenital
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29
Q

primary varicose veins are _______

A

congenital

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30
Q

describe PE

A 
dyspnea (shortness of breath)
chest pain
hemoptysis - blood in sputum
sweats
cough
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31
Q

venous stasis will have _________ and _________ zone

A

ulcerations

gaitor zone - see image on slide 29

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32
Q

define veins

A

thin, echogenically homogeneous walls

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33
Q

peripheral veins return _________ blood back to heart

A

deoxygenated

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34
Q

venous systems of lower and upper extremities consist of _______, ______, and _______ veins

A

superficial
deep
perforating or communicating

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35
Q

perforating veins provide channels between ______ and ______ veins

A

superficial and deep

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36
Q

venous blood flow normally form _______ veins to _______ veins

A

superficial veins to deep veins

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37
Q

deep veins are the primary channels that transport blood from the ______ to the ______

A

extremity to the heart

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38
Q

deep veins are closely associated with the ___________ arteries

A

corresponding

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39
Q

name the deep veins

A 
external iliac
CFV
SFV or FV
DFV or Profunda
POP
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40
Q

name the deep veins of the calf

A

PTV
peroneal
ATV

paired vessels that accompany the artery

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41
Q

define the valves

A

folds of the intima, innermost layer

bicuspid

more numerous in the distal leg

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42
Q

where are there NO valves

A

IVC
SVC
innominate or soleal

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43
Q

_______ drain the dorsum of the foot to form the popliteal vein

A

ATV - anterior tibial veins

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44
Q

______ originate from the planter veins of the foot and receive the peroneal veins before uniting with the anterior to form popliteal

A

PTV - posterior tibial veins

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45
Q

______ drains blood from the lower leg before they join the posterior tibial

A

peroneal

46
Q

______ ______ are large venous reservoirs that empty into the posterior tibial or peroneal

A

soleal sinuses

47
Q

__________ are paired and accompany an artery and terminate at the popliteal

A

gastrocnemius

48
Q

_______ originates from the posterior and peroneal

A

popliteal

49
Q

what is the hardest place to scan on the leg

IMPORTANT

A

hunter’s adductor canal

medial side of the knee

**distal thigh

50
Q

SFV-FV are _____ veins and are buddies with the _____

A

deep

SFA

51
Q

_____ or _____ unites with the SFV or FV to form the CFV

A

deep femoral or profunda

52
Q

the CFV is part of _______ triangle

A

Scarpa’s

53
Q

where your AO splits in the internal and external iliacs and this is called

A

Scarpa’s triangle

54
Q

venous valves are found in the tunica ______

A

intima

allows flow to the heart

55
Q

the left iliac vein can be compressed by the _____ _____ artery

A

right iliac

56
Q

______ ______ vein lies in Scarpa’s triangle medial to the common femoral artery

A

common femoral

57
Q

common femoral vein is formed by confluence of ______ ______ and ______ vein and also receives greater saphencous veins

A

profunda femoris

femoral vein

58
Q

common femoral vein terminates at level of _______ _______ and becomes the ______ ______ vein

A

inguinal ligament

external iliac

59
Q

what veins are part of the lower extremity-superficial

A

GSV
lesser saphenous vein
posterior arch vein
perforating veins

**used for bypass grafts

60
Q

what is the longest vein in the body (lower extremity-superficial)

A

greater saphenous

61
Q

what is the “stocking vein”

A

lesser saphenous joins the popliteal

62
Q

perforating veins flow from ______ to ______

A

superficial to deep

63
Q

the lower extremity deep veins tend to be ______

A

paired

64
Q

describe paired peroneal veins

A

tibioperoneal trunk follo the arteries - venae comitnates

65
Q

describe paired posterior tibial veins

A

tibioperoneal trunk

66
Q

describe paired anterior tibial veins

A

join the tibioperoneal to form the popliteal

67
Q

popliteal vein becomes the _______ vein at the ______ or ______ canal

A

femoral vein

adductor or Hunter’s

68
Q

what should you do if the popliteal vein is hard to compress

A

use hand behind the knee technique

69
Q

popliteal vein is the confluence of the _____ vein and _____/_____ vein — CFV

A

femoral vein

deep/profunda vein

70
Q

_____ _____ vein - dorsum of the foot-groin

A

great saphenous

71
Q

lesser or small saphenous vein joins the ______ vein

A

popliteal

72
Q

reasons for upper extremity scanning

A

pain and swelling of arm or neck
palpable cord
dilated vein
indwelling catheter

73
Q

upper extremity deep system consists of what

A

paired radial and ulnar drain the hand

74
Q

upper extremity paired brachial veins are _____

A

deep

75
Q

______ veins become subclavian vein. why is this difficult to compress

A

axillary vein

clavicle

76
Q

what is the primary root of venous drainage in the upper extremity

A

the superficial system

77
Q

______ vein begins on thumb side of hand

A

cephalic

78
Q

_____ vein originates on the small finger side of hand

A

basilic

79
Q

vessel walls ______ with light or moderate pressure by transducer on skin

A

collapse

80
Q

phasic low-velocity doppler signals augment with ____ ____ compression

A

distal limb

81
Q

common femoral vein change in size with _______

A

respiration

82
Q

what is spontaneous flow

A

flow is present without augmentation maneuvers

83
Q

describe pulsatile signals

A

should be present in jugular, subclavian, innominate, SVC because of retrograde transmission of right artrial pressure

84
Q

describe respiratory phasicity

A

blood flow velocity changes with respiration

upper extremity - venous doppler signal will increase with inspiration and decrease with expiration

85
Q

describe augmentation

A

blood flow velocity increases with distal limb compression or with release of proximal limb compression

**limited in upper extremity exams

86
Q

what happens during respiration in general

A 
diaphragm moves downward
negative chest pressure
venous return to heart increases
venous flow in legs decreases
abd pressure increases
87
Q

in general what happens during expiration

A 
diaphragm moves upward
increasing chest pressure
reduces venous return to the heart
increases venous flow in legs
abd pressure decreases
88
Q

what transducer is used for venous dopplers

A

linear and vascular

12-5 MHz

89
Q

how should the transducer approach the veins

A

perpendicular and do not tilt the transducer

90
Q

angle correction is or is not needed

A

is not

91
Q

what is not measured in a venous doppler

A

velocity

92
Q

spectral doppler is used in long or transverse imaging

A

long

93
Q

patients leg needs to lay in the ______ position

A

“frog” position

knee rolled out

94
Q

what is reversed Trendelenberg

A

patient in supine with their feet higher than their head

95
Q

transverse compressions should be done every ______ cm

A

2-4 cm

96
Q

venous signal should be assessed for what 5 things

A 
spontaneity
phasisity
non-pulsatility
augmentation
competence
97
Q

what is the vein / artery position in the upper leg? how about the lower leg?

A

upper leg - artery on top, vein on bottom

lower leg - artery on bottom, vein on top

98
Q

what are small veins located in the proximal calf by placing the transducer on the later calf in a transverse imaging plan

A

anterior tibial veins

99
Q

where are the ATV located and how do they travel

A

located medial to the fibula in the proximal calf

travel with the anterior tibial artery

100
Q

what veins are located near the medial malleolus and are followed proximally in the calf

A

posterior tibial veins

101
Q

what veins are usually visualized as the transducer is moved a few cms proximally on the calf

A

peroneal veins

102
Q

with doppler, the venous flow is heard and normal flow is characterized as ___________

A

spontaneity

103
Q

doppler consists of what 4 characteristics

A

spontaneous - flow present

phasicity - changes with respiration

augmentation

pulsatile venous signal - jugular, subclavian, innominate, SVC

104
Q

if doppler signal is abnormal and continuous the thrombus may lie closer to the _______

A

heart

105
Q

5 characteristics of venous hemodynamics

A 
spontaneous
phasic with respiration
augments with distal compression
competency - no regurg with prox compression
pulsatility - NOT
106
Q

don’t mix these things with with a blood clot

A

enlarged lymph nodes
hematoma
baker’s cyst - found behind the knee

107
Q

why are veins mapped

A

for path and diameter

**GSV & LSV

108
Q

what is the purpose of superficial vein mapping

A

to determine the vein’s suitability for use as a bypass conduit and identify its anatomic route

109
Q

vein mapping usually is performed before what operations

A

lower extremity arterial bypass or coronary bypass

110
Q

describe venous reflux testing

A

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

111
Q

patients with _____ clots are unlikely to have signs or symptoms of PE

A

calf

112
Q

which vein comes off the common femoral vein first, greater saphenous vein or deep femoral vein

A

GSV branches off before the DFV/Profunda

Summer 2014 - Intro to Vascular ✔️ (7 decks)

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