Peripheral Venous- Upper Flashcards
When does the axillary vein turn into the subclavian?
After it passes the 1st rib
When does the brachial turn into the axillary vein?
When the basilic joins it
What connects the cephalic and basilic veins at the antecubital fossa?
Median cubital vein
Are superficial veins paired with arteries?
No
Clots are made up of what 2 things?
RBC’s and fibrin
How can PE’s be seen? How are they treated?
CT angiography or nuclear medicine VQ lung scan
Thrombectomy via conventional angiography is treatment
Phlegmasia Alba Dolens vs Phlegmasia Cerulea Dolens:
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
Symptoms of SVC syndrome?
neck and face swelling as well as difficulty breathing
blockage of the SVC
What is a gaiter zone
An area superior to the medial mallelous that describes when RBC’s and fluids leak into surrounding tissue and change the color of zine
What’s the most common cause of venous insuffiency?
Previous DVT that damaged the lumen of the veins and rendered the veins incompetent (Post thrombotic syndrome)
Virchows Triad:
Stasis
Hypercoagulopathy
Trauma
What makes pregnant women at a higher risk for a DVT?
Stasis
Main symptoms of an acute DVT:
redness
swelling
warm to the touch
superficial vein dilation
Main symptoms of a chronic DVT:
swelling
discolouration
ulceration
varicose veins
What can be mistaken for a non compressible brachial vein?
brachial nerve
Should you see reversal of flow after release of a distal compression?
Not very much. If anything, only about 0.5-1s of it
Measurement of a perforator? What happens if it’s more than this?
<3mm
Should be suspicious for incompetence
What direction should a perforator be moving?
Away from transducer.
Superficial to deep
What echogenicity is an acute clot?
anechoic/hypoechoic
What is the echogenicity/appearance of a chronic clot?
Increased echogenicity
Firmly adhered to wall
Larger developed collateral wall
Recanalization of vein
What happens when a clot has been there for a while?
It continues to breakdown and is absorbed by the body.
Leaves behind “synechiae”
A lack of spontaneous flow may indicate:
Distal obstruction
An absent/reduced augmentation indicates an obstruction:
Between the two points
When there is a loss of phasicity of the spectral waveform, it is considered:
Continuous
Continuous waveforms indicate:
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
Lack of spontaneity indicates:
distal obstruction
Lack of phasic flow indicates:
proximal obstruction
Lack of continuous waveform in the UE indicates a:
proximal obstruction
but also a loss of pulsatility as well
What is important to recognize when augmenting patient’s in supine vs reverse trendelenberg ?
RT will allow for a longer reflux time
If you see a prolonged period of reversal of flow after compression, what does it indicate?
Venous insuffiency
Venous reflux should measure
0.35-0.5
Photoplethysmography Testing (PPG):
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
What happens on PPG?
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
PPG results:
> 20s = normal
<20s = venous reflux suspected
<10s = severe venous reflux suspected
Can put tourniquet on to see if reflux is superficial or deep
Where is the radiographic content injected in venography?
Foot or groin
First course of treatment with thrombosis?
Injection of Heparin or (Lovenox)
then can do thrombolysis or thrombectomy
Treatments for venous insuffiency?
vein stripping endovenous laser treatment radio freq ablation phlebectomy sclerotherapy
Incompetent perforating veins can be treated with:
EVLT or RFA
The paired posterior tibial veins in the lower leg join in the upper portion of the calf to form the
common tibial trunk
Ascending venograms assess:
thrombosis
Descending venograms assess:
incompetent venous valves
Oral anticoagulation cannot prevent:
scarring, postthrombotic syndrome and cannot serve as a thrombolytic
Which veins of the upper extremity should have cardiac pulsations coupled with respiratory patterns normally?
IJV, brachiocephalic and subclavian veins
What do heel ulcerations indicate?
Peripheral arterial disease, not venous
