Vasc- deep vein imaging

Question 1

What 3 vessels are included in the trifurcation?

Answer 1

1. anterior tibial veins
2. posterior tibial veins
3. peroneal veins

Question 2

where is the trifurcation located?

Answer 2

3 paired vessels arise from the foot and converge to form the popliteal vein

Question 3

where does thromboses more often occur in the trifurcation?

Answer 3

in the peroneal and posterior tibial veins

Question 4

T or F- pulonary embolism can occur from calf vein trombosis

Answer 4

true- although unsusal

Question 5

what is the main drainage conduit for the blood flow from the calf?

Answer 5

popliteal vein

Question 6

what is the popliteal vein accompanied by?

Answer 6

popliteal artery

Question 7

how often may the popliteal vein appear duplicated? (%)

Answer 7

25% of the time

Question 8

what is the duplication of the popliteal vein a result of?

Answer 8

unusually high juncture of posterior tibial and peroneal trunks

Question 9

where do the gastrocnemius veins dump into?

Answer 9

each gastrocnemius vein is a single trunk as it dumps into the popliteal vein just below the SSV juncture

Question 10

What is the gastrocnemius trunk formed by?

Answer 10

• paired veins

- accompanied by a gastrocnemius artery within the gastrocnemius muscle

Question 11

further branching of the gastocnemius veins occurs where?

Answer 11

within the muscle

Question 12

function of gastrocnemius veins?

Answer 12

to drain the muscle

Question 13

where do the gastrocnemius veins disappear?

Answer 13

in the distal muscle

Question 14

what can the gastrocnemius veins be mistaken for?

Answer 14

the PTVV’s

Question 15

where is the soleal sinus vein located?

Answer 15

embedded deep within the soleal muscle

Question 16

function of the soleal sinus veins?

Answer 16

• an extensive network of sinus veins

- major storage of blood

Question 17

where do the soleal sinus veins empty into?

Answer 17

• empty into the posterior tibials or peroneals

Question 18

clots form in the soleal sinus veins due to what?

Answer 18

• stagnation when muscle is inactive

Question 19

most DVT extending into the popliteal vein originate where?

Answer 19

soleal sinus

Question 20

tibioperoneal trunk form what?

Answer 20

the distal popliteal vein

Question 21

what is the most superior branch of the trifurcation?

Answer 21

anterior tibial

Question 22

the tibioperoneal trunk bifurcated into what?

Answer 22

• the common tibial and common peroneal trunks

- then bifurcate into paired tibial and peroneal veins

Question 23

anterior tibials bifurcate where?

Answer 23

• from popliteal vein high in the popliteal fossa as a single trunk

Question 24

the anterior tibials communicate with the soleal sinus T or F?

Answer 24

false

• therefore, almost never develop DVT

Question 25

are anterior tibials tipically included in protocol?

Answer 25

no

- almost never develop DVT and not easily seen

Question 26

where are the posterior tibial veins located and where are they visualized on U/S?

Answer 26

• Paired veins that course near the tibia

- visualized from a medial aspect of the calf

Question 27

where do the posterior tibial veins pass between?

Answer 27

the medial malleolus and Achilles tendon

Question 28

where are the peroneal veins located?

Answer 28

• paired veins that follow a deep course near the fibula

- accompanied by peroneal artery

Question 29

throughout the calf, the paired posterior tibials and peroneals can be viewed where?

Answer 29

side by side from a medial projection

Question 30

what appears larger the posterior tibials or peroneal veins?

Answer 30

peroneal veins

Question 31

where do the peroneal veins pass in the calf?

Answer 31

deep and posterior to the medial malleolus

Question 32

role of sonography in deep vein imaging of the calf (5)?

Answer 32

1. exclude DVT
2. screening tool in post operative lower limb surgery
3. patients with PE, looking for source of embolus
4. thrombosis above tri poses higher risk of embolization
5. R/O popliteal vein involvement

Question 33

How does calf DVT most commonly resolve?

Answer 33

spontaneously

Question 34

Is D-dimer reliable for calf DVT?

Answer 34

no, not reliable only 65% sensitivity

Question 35

is pop vein and FV are patent what is ruled out?

Answer 35

No PE

Question 36

if calf DVT is present what should occur?

Answer 36

repear exam every 2-3 days for propagation

Question 37

how sensitive is doppler for diagnosing calf DVT?

Answer 37

70%

Question 38

what veins are typically large and pose a lesser risk of embolisation?

Answer 38

gastrocs

Question 39

Limitations of deep vein imaging of the calf? (3)

Answer 39

• obese patients
• severe edema
• acoustic windows in patients with open wounds/sutures

Question 40

venous vs. arterial ulcers location in the calf?

Answer 40

• venous ulcers found in medial calf and ankle

- arterial ulcers found in lateral calf, ankle, toes

Question 41

Common differential diagnoses identifiable on ultrasound are? (3)

Answer 41

1. bakers cyst
2. superficial venous thrombosis of varices and GSV/LSV
3. calf muscle tears

Question 42

patient position of deep vein imaging of the calf?

Answer 42

• recumbent with legs lower than torso

- seated with leg over bedside

Question 43

what is a common varient seen in deep vein imaging of calf?

Answer 43

single deep calf vein instead of a pair

• will appear slightly larger than if paired

Question 44

be cautious not to mistake what for the popliteal vein?

Answer 44

the gastrocnemius