Reflux testing Flashcards
The venous system of the lower limb is fragile and easily damages by? (3)
- thrombosis
- trauma
- inflammation
thrombosis may not clear completely resulting in?
chronic obstruction and damage to valves
in limbs affected by DVT ___% had at least one segment of incompetent vein?
69%
In limbs affected by DVT 69% had at least one segment of incompetent vein, this damage results in?
- 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
In limbs affected by DVT 69% had at least one segment of incompetent vein, this damage results in?
- 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
where do veins dialate at normally?
- at the cusps
thrombus typically forms where in relation the valves?
- between the cusps and vein wall
in an erect position varicose veins may extend over?
1.25 meters
in varicose veins the hydrostatic pressures exerted on the tissues interferes with?
- circulation of blood in the capillaries
The hydrostatic pressure exerted on the tissues interferes with circulation of blood in the capillaries and this affects?
the transfer of nutrients and waste matter between blood and the tissues
affected transfer of nutrients and waste matter between blood and the tissues may promote?
local inflammatory responses such as:
- varicose veins
- pigmentation
- ulceration
the pattern of damages and incompetent valves can be defined with?
doppler ultrasound
what can be “mapped out”?
- incompetent venous segments and incompetent perforating vains can be mapped out
mapping can allow for?
appropriate surgical or medical intervention techniques to be applied
vein abaltion treatment?
- a heated catheter is placed within the affected vein essentially closing it
sclerotherapy?
- a solution is injected into the varicose vein, drying it up
3 main patterns of recurrence?
- a patent long saphenous vein may be present suggesting that it may have been missed at the time of operation
- small collateral veins along the line of the long saphenous vein may enlarge to reconstitute the path of the vein
- drainage can occur through venous collaterals which take a variety of courses remote from the normal line of the vein
______ is useful to assess the pattern of recurrence so that appropriate surgical intervention may be planned
colour doppler
At least ____ other tributaries draining to the LSV at the level of the SFJ can be the source of primary or recurrent varicose veins
6
varicose vein mapping- patient position?
- 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
vein mapping time limit?
time-consuming because both legs are examined
with vein mapping where will the patients weight be placed?
on the leg not being examined with slight flexion of the leg being examined
The most convenient method used to assess competence or incompetence of a venous segment is?
to squeeze the patients calf or lower thigh to promote forward flow (augmentation)
incompetent valves?
will allow reverse flow back through them after forward flow has ceased
competent valves will?
stop any reverse flow
what may be applied to induce reverse flow?
proximal compression (above the probe level)
Valsalva manoever will also show incompetent segments
but what are disadvantages to this? (2)
- will only show reverse flow as far as the 1st competent valve, any incompetent valves below this will not be demonstrated
- patients do not always understand the valsalva procedure and may not be consistent
When Valsalva manoever is not effective, what can be used?
augmentation can be used to assess for reflux
augmentation is particularly helpful in what area?
- popliteal vein and calf veins
when augmentation is done, immediatly after what should you see?
the flow should return below the basline
if when augmentation is done and immediatly after returns above the baseline this is an indication that?
there are incompetent valves below this level
define reflux?
reverse flow occuring after the cessation of forward flow
reflux is concidered significant if it lasts for more than?
0.5s
shorter periods of reversed flow may represent?
the valve cusps coming together (slow closing valves)
Reflux should not be confused with?
- reversal of flow which occurs with turbulence
- this is seen on spectral doppler as reverse flow and forward flow occurring at the same time
If previous surgery has been performed , the SFJ must be examined carefully to assess?
- possibility of significant collaterals
- recanalized segments that may have been left behind
The loss of the normal smooth curve of the Saphenous vein as it passes laterally and deeply towards the CFV is suggestive of?
previous surgeru with subsequent recanalization or collateral formation
The most common location for an incompetent perforating vein is at the level of the?
junction of the mid and lower thirds of the thigh
- named the mid thigh perforating vein or hunterian perforator
Protocol-knee level?
- 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
It is difficult or impossible to induce significant forward flow in the?
- calf vessels as well as reflux
- valsalva is not reliable at this level
Protocol-calf veins?
- 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
how should varices be traced?
- proximally to identify the point of communication with deep or superficial segments
- care must be taken not to compress superficial veins with probe pressure
what are perforator vains?
- veins that perforate the deep fascia of muscles, to connect the superficial veins to the deep veins where they drain into
perforator function?
- maintain correct blood draining
do perforators contain veins?
yes, the have valves which prevent blood flowing back from deep to superficial veins in muscular systole or contraction
where do perforators live?
- the exist along the length of the leg
- in greater number in the calf than int he thigh
where is Dodd’s perforator?
at the inferior 1/3 of the thigh
where is boyd’s perforator?
at the knee level
where is cockett’s perforators?
- inferior 2/3 of the leg
usually there are 3:
- superior
- medium
- inferior
When the valves of perforator veins become incompetent they can cause?
- 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
abnormal perforator measurement in calf and thigh?
calf: >3mm
thigh: >4mm
