Peripheral Venous- Upper

Question 1

When does the axillary vein turn into the subclavian?

Answer 1

After it passes the 1st rib

Question 2

When does the brachial turn into the axillary vein?

Answer 2

When the basilic joins it

Question 3

What connects the cephalic and basilic veins at the antecubital fossa?

Answer 3

Median cubital vein

Question 4

Are superficial veins paired with arteries?

Answer 4

No

Question 5

Clots are made up of what 2 things?

Answer 5

RBC’s and fibrin

Question 6

How can PE’s be seen? How are they treated?

Answer 6

CT angiography or nuclear medicine VQ lung scan

Thrombectomy via conventional angiography is treatment

Question 7

Phlegmasia Alba Dolens vs Phlegmasia Cerulea Dolens:

Answer 7

Both are caused by an obstruction in the iliofemoral vein (causing a DVT) which causes extreme swelling. Alba does not have skin color changes, whereas cerulea has cyanosis and reduced arterial flow which is limb threatening

Question 8

Symptoms of SVC syndrome?

Answer 8

neck and face swelling as well as difficulty breathing

blockage of the SVC

Question 9

What is a gaiter zone

Answer 9

An area superior to the medial mallelous that describes when RBC’s and fluids leak into surrounding tissue and change the color of zine

Question 10

What’s the most common cause of venous insuffiency?

Answer 10

Previous DVT that damaged the lumen of the veins and rendered the veins incompetent (Post thrombotic syndrome)

Question 11

Virchows Triad:

Answer 11

Stasis
Hypercoagulopathy
Trauma

Question 12

What makes pregnant women at a higher risk for a DVT?

Answer 12

Stasis

Question 13

Main symptoms of an acute DVT:

Answer 13

redness
swelling
warm to the touch
superficial vein dilation

Question 14

Main symptoms of a chronic DVT:

Answer 14

swelling
discolouration
ulceration
varicose veins

Question 15

What can be mistaken for a non compressible brachial vein?

Answer 15

brachial nerve

Question 16

Should you see reversal of flow after release of a distal compression?

Answer 16

Not very much. If anything, only about 0.5-1s of it

Question 17

Measurement of a perforator? What happens if it’s more than this?

Answer 17

<3mm

Should be suspicious for incompetence

Question 18

What direction should a perforator be moving?

Answer 18

Away from transducer.

Superficial to deep

Question 19

What echogenicity is an acute clot?

Answer 19

anechoic/hypoechoic

Question 20

What is the echogenicity/appearance of a chronic clot?

Answer 20

Increased echogenicity
Firmly adhered to wall
Larger developed collateral wall
Recanalization of vein

Question 21

What happens when a clot has been there for a while?

Answer 21

It continues to breakdown and is absorbed by the body.

Leaves behind “synechiae”

Question 22

A lack of spontaneous flow may indicate:

Answer 22

Distal obstruction

Question 23

An absent/reduced augmentation indicates an obstruction:

Answer 23

Between the two points

Question 24

When there is a loss of phasicity of the spectral waveform, it is considered:

Answer 24

Continuous

Question 25

Continuous waveforms indicate:

Answer 25

A more proximal obstruction For example, if a normal phasic waveform was obtained in the right CFV and on the left more of a continuous type flow pattern was obtained it might suggest that there is an obstruction of the left external or common iliac vein

Question 26

Lack of spontaneity indicates:

Answer 26

distal obstruction

Question 27

Lack of phasic flow indicates:

Answer 27

proximal obstruction

Question 28

Lack of continuous waveform in the UE indicates a:

Answer 28

proximal obstruction | but also a loss of pulsatility as well

Question 29

What is important to recognize when augmenting patient's in supine vs reverse trendelenberg ?

Answer 29

RT will allow for a longer reflux time

Question 30

If you see a prolonged period of reversal of flow after compression, what does it indicate?

Answer 30

Venous insuffiency

Question 31

Venous reflux should measure

Answer 31

0.35-0.5

Question 32

Photoplethysmography Testing (PPG):

Answer 32

Evaluates venous insufficiency PPG sensor uses infrared light that is reflected off blood cells in the cutaneous vessels, and used to detect the return of blood flow following flexion manuevers

Question 33

What happens on PPG?

Answer 33

Calf is pumped, blood empties from calf and the tracing drops considerably then gradually returns to normal. Can place tourniquets for evaluating the level of insuffiency

Question 34

PPG results:

Answer 34

>20s = normal <20s = venous reflux suspected <10s = severe venous reflux suspected Can put tourniquet on to see if reflux is superficial or deep

Question 35

Where is the radiographic content injected in venography?

Answer 35

Foot or groin

Question 36

First course of treatment with thrombosis?

Answer 36

Injection of Heparin or (Lovenox) then can do thrombolysis or thrombectomy

Question 37

Treatments for venous insuffiency?

Answer 37

``` vein stripping endovenous laser treatment radio freq ablation phlebectomy sclerotherapy ```

Question 38

Incompetent perforating veins can be treated with:

Answer 38

EVLT or RFA

Question 39

The paired posterior tibial veins in the lower leg join in the upper portion of the calf to form the

Answer 39

common tibial trunk

Question 40

Ascending venograms assess:

Answer 40

thrombosis

Question 41

Descending venograms assess:

Answer 41

incompetent venous valves

Question 42

Oral anticoagulation cannot prevent:

Answer 42

scarring, postthrombotic syndrome and cannot serve as a thrombolytic

Question 43

Which veins of the upper extremity should have cardiac pulsations coupled with respiratory patterns normally?

Answer 43

IJV, brachiocephalic and subclavian veins

Question 44

What do heel ulcerations indicate?

Answer 44

Peripheral arterial disease, not venous