Quiz 5 Flashcards
what are the three paired vessels that arise from the foot and converge to form the popliteal vein?
- anterior tibial veins
- posterior tibial veins
- peroneal veins
where does thromboses occur more often?
in the peroneal and posterior tibial veins
can PE occur from calf vein thrombus?
yes but it is unusual
what is the main drainage conduit for the blood flow from the calf?
popliteal vein
what is popliteal accompanied by?
popliteal artery
______ of the time, the popliteal vein may be duplicated?
25%
where does the Gastrocnemius veins dump into?
single trunk dumps into the popliteal vein just below the SSV juncture
how is each “gastroc” trunk formed?
formed by paired veins, accompanied by a gastrocnemius artery within the Gastrocnemius muscle
what do the Gastrocnemius veins do?
serve to drain the muscle, they eventually disappear in the distal muscle
what can the Gastrocnemius veins be mistaken for?
the PTVV’s
where are the soleal sinus veins?
embedded deep within the soleal muscle
where is the major storage of blood?
soleal sinus veins
where do the soleal sinus veins empty?
into the posterior tibials or peroneals
how do clots form in the soleal sinus veins?
due to stagnation when muscle is inactive
where do most DVT extending into the pop V originate?
soleal sinus veins
what is the most superior branch of the trifurcation?
anterior tibial trunk
what can be found below the level of the anterior tibial trunk?
tibioperoneal trunk
what does the Tibioperoneal trunk bifurcate into?
common tibial
common peroneal
where do the anterior tibials bifurcacte from?
pop vein high in the pop fossa as a single trunk
is the anterior trunk easily seen on ultrasoud?
no
where would we visualize the remainder of the anterior tibial?
anterolateral projection
do the anterior tibials communicate with the soleal sinuses?
no
do the anterior tibials develop DVT’s?
not often
where are the posterior tibial veins?
course near the tibia
how are the posterior tibial veins visualized?
medial aspect of the calf
where does the posterior tibial veins pass?
between the medial malleolus and the achilles tendon
where do the peroneal veins course near?
the fibula
how are the paired posterior tibials and peroneals viewed/
side by side in the calf from a medial projection
what veins typically appear larger?
peroneal are typically larger than the posterior tibials
where do the peroneal veins pass?
deep and posterior to the medial malleolus
what is the role of US for veins in the calf?
- exclude DVT as a cause for pain and swelling in the lower limb
- screening tool in post operative lower limb surgery
- looking for source of PE
what poses a higher risk of embolism?
thrombosis above the trifircation
-R/O popliteal involvment
what happens to calf DVT’s?
most resolve spontaneously
is D-Dimer useful for calf DVT?
no, 65% sensitivityq
what can we exclude if Pop V and FV are patent?
no PE
what must be done for screening with calf veins?
repeat exam every 2-3 days
doppler is only ______ sensitive for diagnosing calf DVT
70%
are gastrocs considered true deep veins?
not truely deep veins but are generally large and still pose a risk for embolisation
what are limitations for calf DVT scan?
- obese patients
- those with sever edema
- acoustic windows and detail may be limited in patients with open wounds/sutures
what are differential diagnosis of calf DVT?
- bakers cyst in medial popliteal fossa
- superficial venous thrombosis of varices and the long/short saphenous veins
- calf muscle tears
are the anterior tibial veins examined?
no becuase they are so rarely subject to thrombosis
when should the anterior tibial vein be examined?
if there has been direct trauma to the anterior-lateral shin
how do you find the paired posterior tibial and peroneal veins?
TRV with the toe of the probe on the medial edge of the mid tibia
what is a common varient for the calf veins?
single calf vein instead of a pair and it will be larger
where do you begin to find the pop vein?
knee crease in to pop fossa
what must you be careful not to mistake the popliteal vein for?
gastrocnemius veins
where are superficial leg veins located?
near the skin, superficial to the muscle
do superficial veins travel with an artery?
no
what do superficial veins travel inbetween?
within the border that seperates the fascia from the muscle
what is the superficial leg veins primary job?
get blood close to the skin surface so the veins can regulate body temperature
what does the superficial veins do in the cold?
constrict to help preserve body heat
where does the LSV (GSV) arise from?
medial aspect of the dorsal venous arch of the foot
what is the path of the LSV (GSV)?
in front of the medial malleolus to run up the medial aspect of the calf and knee into the thigh
where does the LSV (GSV) join the CFV?
in the upper thigh the LSV curves laterally and deeply to join the CFV just below the inguinal ligament
what are the 2 components in the calf?
- posterior division
- anterior division
what is the posterior division?
passes up from the medial malleolus and communicates with the perforator veins
what is the anterior division?
joins the posterior division just below the knee
what is a tip when scanning the LSV (GSV) down the leg?
scan on the medial aspect of the leg and if you find yourself moving anteriorly or posteriorly you are in a branch and need to start over
where does the LSV (GSV) end?
point anterior to the medial malleolus
where does the LSV (GSV) run between?
2 hyperechoic fascia-becomes smaller caudally
descrive the egyptian eye appearance?
normal LSV with the fascial sheath
how often can duplication of the LSV be seen in the thigh?
up tp 50% of people
how is the LSV (GSV) connected to the deep veins?
perforating veins
what does the LSV (GSV) recieve?
many tributaries
how does the LSV enter the femoral vein?
through the fossa ovalis
what must the veins entering the saphenous bulb do to prevent recurrence of varicose veins?
must be ligated (tied up)
what are the 2 small veins that go into the saphenous bulb?
superficial circumflex
pedundal branches
how many tributaries drain into the SFV?
6 other tributaties from the groin, lower abdominal wall and perineum
when a thrombus is seen in the superfical system, what measurment of the thrombus to the deep system will the clinicians give the patient anticoagulate?
0.5 - 1cm of the SFJ
what happens when therre is a LSV thrombus?
vein dilates and becomes tortuous
do superficial veins with thrombus pose a threat for PE?
yes
why are superficial veins less likely to cause PE?
not surrounded by muscle so they are less likely to dislodge compared to deep veins
what are clinical signs of SVT?
- Severe pain and tenderness
- Redness
- Inflammation
- Swelling
- Pyrexia(fever)
- Palpable cord
what are the most common entities that are confused with SVT?
- lymphangitis
- cellulitis
SVT is associated with an occult DVT _________ of the time
20%
what does LSV flow with femoral vein obstruction look like?
high volume spontaneous flow-collateral
duplicated SV below knee in ____ of cases
30%
what does the posterior accessory vein communicate with?
PTV via perforating veins-medial calf perforator
where does the SSV (LSV) vein arise from?
lateral aspect of the dorsal venous arch of the foot
what is the path of the SSV (LSV)?
Passes below and behind the lateral malleolus to run up the posterolateral aspect of the calf to the popliteal fossa
what does the SSV join?
the popliteal vein at the crease level
what is the giacomini vein?
SSV passes upwards to join the profunda femoris vein in the lower thigh
where does the short saphenous vein (SSV) originate?
lateral aspect of the foot
what are perforator veins?
veins that connect the superficial veins to the deep veins
what is the purpose of the perforator veins?
keep blood from pooling at the skin level
what happens when perforator valves malfunction?
blood pools at the skin level resulting in chronic stasis, changes and ulcers may develop
what are standard sites for the perforators?
level of the junction of the middle and lower thirds of the thigh and in the calf
what happens with incompetent deep veins and perforating veins?
venous hypertension below the fascia of the leg is transmitted to the superficial system
what are the upper extremity SVT?
basilic and cephalic
where do the basilic and cephalic veins dump?
dump into the subclavian vein at the axillary vein junction
what is the most common cause if SVT in the upper extremity?
- intravenous infusions that inflict a chemical injury on the vein wall which leads to inflammation and inevitably thrombosus
- trousseaus syndrome and buerger’s disease
what often accompanies DVT in the upper extremity veins?
- tender palpable cord in the neck and/or axilla
- a bluish or cyanotic discoloration in hand and fingers
- aching pain in the forarm exacerbated by exercise
