Reflux testing

Question 1

The venous system of the lower limb is fragile and easily damages by? (3)

Answer 1

• thrombosis
• trauma
• inflammation

Question 2

thrombosis may not clear completely resulting in?

Answer 2

chronic obstruction and damage to valves

Question 3

in limbs affected by DVT ___% had at least one segment of incompetent vein?

Answer 3

69%

Question 4

In limbs affected by DVT 69% had at least one segment of incompetent vein, this damage results in?

Answer 4

• loss of the protective action of the valves creating a constant column of blood between the heart and tissues of the calf, ankle, and foot

Question 4

In limbs affected by DVT 69% had at least one segment of incompetent vein, this damage results in?

Answer 4

• loss of the protective action of the valves creating a constant column of blood between the heart and tissues of the calf, ankle, and foot

Question 5

where do veins dialate at normally?

Answer 5

• at the cusps

Question 6

thrombus typically forms where in relation the valves?

Answer 6

• between the cusps and vein wall

Question 7

in an erect position varicose veins may extend over?

Answer 7

1.25 meters

Question 8

in varicose veins the hydrostatic pressures exerted on the tissues interferes with?

Answer 8

• circulation of blood in the capillaries

Question 9

The hydrostatic pressure exerted on the tissues interferes with circulation of blood in the capillaries and this affects?

Answer 9

the transfer of nutrients and waste matter between blood and the tissues

Question 10

affected transfer of nutrients and waste matter between blood and the tissues may promote?

Answer 10

local inflammatory responses such as:

• varicose veins
• pigmentation
• ulceration

Question 11

the pattern of damages and incompetent valves can be defined with?

Answer 11

doppler ultrasound

Question 12

what can be “mapped out”?

Answer 12

• incompetent venous segments and incompetent perforating vains can be mapped out

Question 13

mapping can allow for?

Answer 13

appropriate surgical or medical intervention techniques to be applied

Question 14

vein abaltion treatment?

Answer 14

• a heated catheter is placed within the affected vein essentially closing it

Question 15

sclerotherapy?

Answer 15

• a solution is injected into the varicose vein, drying it up

Question 16

3 main patterns of recurrence?

Answer 16

1. a patent long saphenous vein may be present suggesting that it may have been missed at the time of operation
2. small collateral veins along the line of the long saphenous vein may enlarge to reconstitute the path of the vein
3. drainage can occur through venous collaterals which take a variety of courses remote from the normal line of the vein

Question 17

______ is useful to assess the pattern of recurrence so that appropriate surgical intervention may be planned

Answer 17

colour doppler

Question 18

At least ____ other tributaries draining to the LSV at the level of the SFJ can be the source of primary or recurrent varicose veins

Answer 18

6

Question 19

varicose vein mapping- patient position?

Answer 19

• patient is examined standing or with a large degree of head up tilt of the examination table
• ensures adequate pressure will be exerted on the valves to test their competence

Question 20

vein mapping time limit?

Answer 20

time-consuming because both legs are examined

Question 21

with vein mapping where will the patients weight be placed?

Answer 21

on the leg not being examined with slight flexion of the leg being examined

Question 22

The most convenient method used to assess competence or incompetence of a venous segment is?

Answer 22

to squeeze the patients calf or lower thigh to promote forward flow (augmentation)

Question 23

incompetent valves?

Answer 23

will allow reverse flow back through them after forward flow has ceased

Question 24

competent valves will?

Answer 24

stop any reverse flow

Question 25

what may be applied to induce reverse flow?

Answer 25

proximal compression (above the probe level)

Question 26

Valsalva manoever will also show incompetent segments

but what are disadvantages to this? (2)

Answer 26

1. will only show reverse flow as far as the 1st competent valve, any incompetent valves below this will not be demonstrated
2. patients do not always understand the valsalva procedure and may not be consistent

Question 27

When Valsalva manoever is not effective, what can be used?

Answer 27

augmentation can be used to assess for reflux

Question 28

augmentation is particularly helpful in what area?

Answer 28

• popliteal vein and calf veins

Question 29

when augmentation is done, immediatly after what should you see?

Answer 29

the flow should return below the basline

Question 30

if when augmentation is done and immediatly after returns above the baseline this is an indication that?

Answer 30

there are incompetent valves below this level

Question 31

define reflux?

Answer 31

reverse flow occuring after the cessation of forward flow

Question 32

reflux is concidered significant if it lasts for more than?

Answer 32

0.5s

Question 33

shorter periods of reversed flow may represent?

Answer 33

the valve cusps coming together (slow closing valves)

Question 34

Reflux should not be confused with?

Answer 34

• reversal of flow which occurs with turbulence

- this is seen on spectral doppler as reverse flow and forward flow occurring at the same time

Question 35

If previous surgery has been performed , the SFJ must be examined carefully to assess?

Answer 35

• possibility of significant collaterals

- recanalized segments that may have been left behind

Question 36

The loss of the normal smooth curve of the Saphenous vein as it passes laterally and deeply towards the CFV is suggestive of?

Answer 36

previous surgeru with subsequent recanalization or collateral formation

Question 37

The most common location for an incompetent perforating vein is at the level of the?

Answer 37

junction of the mid and lower thirds of the thigh

• named the mid thigh perforating vein or hunterian perforator

Question 38

Protocol-knee level?

Answer 38

• turn patient so the popliteal region can assess with the knee partially flexed
• assess popliteal vein and sapheno-popliteal junction
• recurrence after surgery can alter the usual pattern of flow

Question 39

It is difficult or impossible to induce significant forward flow in the?

Answer 39

• calf vessels as well as reflux

- valsalva is not reliable at this level

Question 40

Protocol-calf veins?

Answer 40

• Use proximal compression in the thigh region
• Incompetent calf perforators should be sought using color Doppler
• Look for outward flow from the deep to superficial systems

Question 41

how should varices be traced?

Answer 41

• proximally to identify the point of communication with deep or superficial segments
• care must be taken not to compress superficial veins with probe pressure

Question 42

what are perforator vains?

Answer 42

• veins that perforate the deep fascia of muscles, to connect the superficial veins to the deep veins where they drain into

Question 43

perforator function?

Answer 43

• maintain correct blood draining

Question 44

do perforators contain veins?

Answer 44

yes, the have valves which prevent blood flowing back from deep to superficial veins in muscular systole or contraction

Question 45

where do perforators live?

Answer 45

• the exist along the length of the leg

- in greater number in the calf than int he thigh

Question 46

where is Dodd’s perforator?

Answer 46

at the inferior 1/3 of the thigh

Question 47

where is boyd’s perforator?

Answer 47

at the knee level

Question 48

where is cockett’s perforators?

Answer 48

• inferior 2/3 of the leg

usually there are 3:

• superior
• medium
• inferior

Question 49

When the valves of perforator veins become incompetent they can cause?

Answer 49

• venous reflux when the muscles contract
• this is active venous reflux

The resulting reflux can cause a rapid deterioration in an existing varicose disease and be responsible for the development of venous ulcers

Question 50

abnormal perforator measurement in calf and thigh?

Answer 50

calf: >3mm
thigh: >4mm