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Vascular > Peripheral Venous Evaluation > Flashcards

Peripheral Venous Evaluation Flashcards

0
Q

What is key in a venous evaluation?

A

compression

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1
Q

What are you looking for in the venous evaluation?

A

Thrombus ( not stenosis)

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2
Q

Since velocities are not measured do you need an angle correction?

A

no

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3
Q

A venous study in an __________ study.

A

emergent (emergency)

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4
Q

Do we measure velocity in a vein?

A

no - we just want to know if there is flow

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5
Q

When is a DVT acute?

A

within the first 14 days

vein wall is inflamed and thrombus is loosely attached

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6
Q

How does an acute DVT look on US?

A

low echogenicity

distended vein

loss of compressibility

free floating thrombus

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7
Q

New thrombus is _________ or __________mass

A

hypoechoic

anechoic

vein walls will not compress

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8
Q

What does a chronic DVT look like?

A

more echogenic

diffuse wall thickening

scarred vein

size of thrombus is reduced

attached to the vein wall

rigid

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9
Q

Chronic DVT has ____________ and _______________vein protrusions

A

hyperechoic

heterogenous

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10
Q

What is the complication of acute DVT?

A

lethal

Pulmonary Emboli (PE)

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11
Q

What are the main goals of treating DVT

A

Stop the clot from getting bigger

prevent the clot from breaking off and moving to your lungs

reduce your chance of having another blood clot

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12
Q

What are the two blood thinners used to treat DVT?

A

warfarin (pill aka coumadin)

heparin (injection IV tube)

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13
Q

What is a vena cava filter?

A

for people with lots of problems with DVT’s - will catch the clots

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14
Q

What are the risk factors for DVT?

A

Age

post operative

malignancy

Previous DVT*

Immobility

pelvic, hip or bone fracture

MI, Stroke, CHF, respiratory failure

pregnancy

oral contraceptives

trauma

central venous lines, pacemakers (DVT in the arms)

IV drug abuse

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15
Q

What is Virchow’s Triad?

A

Hypercoagulable state of blood

venous stasis (blood pools in the veins)

Vein wall injury

these three things cause DVT

***doctor from 1800’s - DID NOT USE ULTRASOUND

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16
Q

What is a hypercoagulable state?

A

abnormally increased tendency toward blood clotting

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17
Q

What is venous stasis?

A

slow blood flow especially in legs

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18
Q

What are the clinical findings of DVT?

A

tenderness/pain

persistent leg or arm swelling

edema

warmth

redness ( erythema)

asymptomatic

variable and unreliable

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19
Q

With a DVT where does the leg hurt?

A

typically in the back or side

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20
Q

What is homan’s sign?

A

the foot is flexed, if there is a DVT it will produce more pain in the leg

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21
Q

What is the difference between DVT and Insufficiency?

A

DVT Insufficiency

acute limb swelling recurrent limb swelling

recent onset pain varicose veins

local tenderness chronic leg heaviness

limb warmth statis dermatitis

shortness of breath (PE) ulceration

emergent non emergent

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22
Q

What does superficial venous thrombosis look like

A

local erythema

palpable subcutaneous cord

dilated

elongated

torturous

weakness of walls

congenital

NOT DVT*

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23
Q

What are the symptoms of pulmonary embolus?

A

dyspnea (shortness of breath)

chest pain

hemoptysis (blood in sputum)

sweats cough

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24
Q

What are some complications of venous statsis?

A

ulcerations

Gaitor Zone - right above the ankle ulcerations

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25
Q

How should a normal vein appear?

A

thin walls

clear lumen

compressible

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26
Q

What are the different kinds of veins?

A

deep veins

communicating or perforating veins

superficial veins

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27
Q

See slide 33

A

diagram

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28
Q

What do the deep veins do?

A

primary channels that transport blood fro the extremity to the heart

close association with corresponding arteries

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29
Q

what are the deep veins?

A

external iliac

CFV (common femoral vein)

SFV (superficial femoral vein that’s not actually superficial) or FV (femoral vein)

DFV (deep femoral vein) or profunda

POP (popliteal)

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30
Q

What are the deep veins of the calf?

A

PTV (posterior tibial vein)

Peroneal

ATV (anterior tibial vein)

paired vessels that accompany artery

see slide 36 for picture

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31
Q

What is the anatomy of the vein?

A

veins have valves

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32
Q

What is a valve?

A

folds of the intima

bicuspid

more numerous in distal leg

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33
Q

What veins don’t have valves

A

IVC

SVC

innominate

soleal

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34
Q

What does the anterior tibial vein drain?

A

the dorsum of the foot to form the popliteal vein

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35
Q

Where do the posterior tibial veins orginate?

A

from the plantar veins of the foot

receive the Peroneal veins before uniting with the anterior to form popliteal

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36
Q

Peroneal drain blood from the _______ ________before they join the _________ _________

A

lower leg

posterior tibial

37
Q

What are soleal sinuses?

A

large venous reservoirs

empty into the posterior tibial or peroneal

38
Q

Where does the gastrocnemius terminate?

A

paired and accompany arteries

terminate at popliteal

39
Q

The popliteal orginates from the _________ and _________

A

posterior tib

peroneal

40
Q

Where is the Hunter’s adductor canal?

A

the hardest part to scan

the side of the knee - medial side

must compress, hard to do because of the bone in the way

41
Q

How do you recognize the FV?

A

deep vein

buddy’s with Superficial Femoral Artery

if you see the vein and no artery, you are in the wrong vein

42
Q

How do you recognize the deep femoral or profunda?

A

unites with the SFV or FV to form the CFV

branches off…femoral will continue with the artery

slide 58 for image

43
Q

Where is Scarpa’s triangle?

A

Where the aorta and IVC and the iliacs split into the groin

44
Q

What vessels are in the superficial system?

A

GSV

lesser saphenous vein

posterior arch vein

perforating veins

used for bypass grafts

45
Q

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

A

common femoral vein

46
Q

What is the longest vein in the body?

A

greater saphenous

47
Q

Where is the lesser saphenous?

A

joins the popliteal

“stocking vein”

superficial vein

48
Q

What is a perforating vein?

A

connects the superficial and deep veins

see slide 75 for picture

49
Q

Which veins are paired?

A

peroneal veins

post tib

anterior tib

50
Q

what veins join the popliteal?

A

lesser or small saphenous vein

51
Q

What might you find in the upper extremity veins?

A

pain and swelling of the arm or neck

palpable cord

dilated vein

indwelling catheter

52
Q

What are the paired veins in the upper extremity deep system?

A

radial and ulnar drain the hand

53
Q

What are the veins of the deep venous system of the arm?

A

deep palmar network

radial vein

ulnar vein

brachial veins

axillary vein

subclavian vein

54
Q

which vein is difficult to compress in the arm?

A

subclavian vein due to clavicle

55
Q

the primary root of venous drainage in the upper extremity is the ______________ ____________

A

superficial system

56
Q

what vein begins on the small finger side of the hand?

A

basilic vein

57
Q

Which vein comes out on the thumb side?

A

cephalic vein

58
Q

What are the characteristics of normal veins in the upper extremity?

A

spontaneous: flow is present w/o augmentation

Pulsatility:

respiratory phasicity

augmentation

59
Q

What was the method of choice before US for looking for clots?

A

Contrast venography

60
Q

What is photoplethysmography?

A

uses light to assess reflux and incompetence

61
Q

What happens to the veins during inspiration?

A

diaphragm moves downward

negative chest pressure

venous return to the heart INCREASES

INCREASES venous flow in the LEGS

abdominal pressure DECREASES

62
Q

What transducer are you going to use?

A

Linear AND vascular

12-5 MHz

63
Q

What is the key to tell if there is a clot?

A

Compression (aka coaptation)

try to be perpendicular

do NOT tilt the transducer

64
Q

Do you need angle correction?

A

not needed because we are not measuring velocity

65
Q

What is the patient position for a venous scan?

A

reverse trendelenburg - head up feet down

have them roll their leg a little - frog position

66
Q

What is formed by the confluence of profunda femoris and femoral vein and also receives the greater saphenous vein?

A

common femoral vein

66
Q

What vein extends from the groin to the dorsum of the foot?

A

Great Saphenous

67
Q

What is pulsatility?

A

because of retrograde transmission of right atrial pressure

present in jugular, subclavian, innominate, and SVC

68
Q

What is respiratory phasicity?

A

blood flow velocity changes with respiration

in upper extremity (central veins), venous doppler signal will increase with inspiration and decrease with expiration

69
Q

What is augmentation?

A

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

70
Q

What contracts in order to expand the thorax for inspiration?

A

the diaphragm

71
Q

What happens to the body during inspiration?

A

diaphragm moves downward

negative chest pressure

venous return to the heart increases

venous flow in the legs decreases

abdominal pressure increases

72
Q

What happens to the body durning expiration?

A

diaphragm moves upward

increasing chest pressure

reduces venous return to the heart

increases venous flow in the legs

abdominal pressure decreases

73
Q

What vessels are in your first picture of venous leg study?

A

common femoral artery GSV (SFJ)
common femoral vein

makes a Mickey Mouse sign

74
Q

How far should you go before you compress?

A

every 2-3 cm

75
Q

Where are the anterior tibial veins located?

A

small

located in the prox calf

place transducer on lateral calf

travel with anterior tibial artery

travels with the anterior tibial artery

medial to fibula in prox calf

76
Q

Where are the posterior tibial veins located?

A

near the medial malleolus (ankle bone) and followed proximally in the calf

77
Q

How are the peroneal veins visualized?

A

transducer is moved a few cm prox on the calf

78
Q

with doppler the __________flow is heard and normal flow is characterized as ____________

A

venous

spontaneity

79
Q

if the signal is abnormal and continuous the thrombus may lie ________ to the _________

A

closer

heart

ex: if CFV doppler is continuous there may be thrombus in the iliac vein

80
Q

What are the venous hemodynamics?

A

spontaneous

phasic with respiration

augments w/distal compression

competency - no regurg with prox compression

NO Pulsatility

81
Q

What cyst do you find behind the knee?

A

Baker’s Cyst

82
Q

What is vein mapping?

A

to determine the veins suitability for use as a bypass conduit and identify its anatomic route

83
Q

When is vein mapping performed?

A

before lower extremity arterial bypass or coronary bypass operations

84
Q

What is venous reflux?

A

insufficience

incompetent venous valves

85
Q

What does venous reflux testing do?

A

identify the presence and location of incompetent venous valves

86
Q

how is a venous reflux test done?

A

performed with the patient standing

87
Q

when are valves considered incompetent?

A

if retrograde blood flow is present and lasts greater than 1 second

88
Q

What is spontaneous flow?

A

Blood that flows without augmentation

89
Q

What three things might fool you into thinking its thrombus?

A

lymph node

hematoma

baker’s cyst

Vascular (6 decks)

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