Vasc- deep vein imaging Flashcards
What 3 vessels are included in the trifurcation?
- anterior tibial veins
- posterior tibial veins
- peroneal veins
where is the trifurcation located?
3 paired vessels arise from the foot and converge to form the popliteal vein
where does thromboses more often occur in the trifurcation?
in the peroneal and posterior tibial veins
T or F- pulonary embolism can occur from calf vein trombosis
true- although unsusal
what is the main drainage conduit for the blood flow from the calf?
popliteal vein
what is the popliteal vein accompanied by?
popliteal artery
how often may the popliteal vein appear duplicated? (%)
25% of the time
what is the duplication of the popliteal vein a result of?
unusually high juncture of posterior tibial and peroneal trunks
where do the gastrocnemius veins dump into?
each gastrocnemius vein is a single trunk as it dumps into the popliteal vein just below the SSV juncture
What is the gastrocnemius trunk formed by?
- paired veins
- accompanied by a gastrocnemius artery within the gastrocnemius muscle
further branching of the gastocnemius veins occurs where?
within the muscle
function of gastrocnemius veins?
to drain the muscle
where do the gastrocnemius veins disappear?
in the distal muscle
what can the gastrocnemius veins be mistaken for?
the PTVV’s
where is the soleal sinus vein located?
embedded deep within the soleal muscle
function of the soleal sinus veins?
- an extensive network of sinus veins
- major storage of blood
where do the soleal sinus veins empty into?
- empty into the posterior tibials or peroneals
clots form in the soleal sinus veins due to what?
- stagnation when muscle is inactive
most DVT extending into the popliteal vein originate where?
soleal sinus
tibioperoneal trunk form what?
the distal popliteal vein
what is the most superior branch of the trifurcation?
anterior tibial
the tibioperoneal trunk bifurcated into what?
- the common tibial and common peroneal trunks
- then bifurcate into paired tibial and peroneal veins
anterior tibials bifurcate where?
- from popliteal vein high in the popliteal fossa as a single trunk
the anterior tibials communicate with the soleal sinus T or F?
false
- therefore, almost never develop DVT
are anterior tibials tipically included in protocol?
no
- almost never develop DVT and not easily seen
where are the posterior tibial veins located and where are they visualized on U/S?
- Paired veins that course near the tibia
- visualized from a medial aspect of the calf
where do the posterior tibial veins pass between?
the medial malleolus and Achilles tendon
where are the peroneal veins located?
- paired veins that follow a deep course near the fibula
- accompanied by peroneal artery
throughout the calf, the paired posterior tibials and peroneals can be viewed where?
side by side from a medial projection
what appears larger the posterior tibials or peroneal veins?
peroneal veins
where do the peroneal veins pass in the calf?
deep and posterior to the medial malleolus
role of sonography in deep vein imaging of the calf (5)?
- exclude DVT
- screening tool in post operative lower limb surgery
- patients with PE, looking for source of embolus
- thrombosis above tri poses higher risk of embolization
- R/O popliteal vein involvement
How does calf DVT most commonly resolve?
spontaneously
Is D-dimer reliable for calf DVT?
no, not reliable only 65% sensitivity
is pop vein and FV are patent what is ruled out?
No PE
if calf DVT is present what should occur?
repear exam every 2-3 days for propagation
how sensitive is doppler for diagnosing calf DVT?
70%
what veins are typically large and pose a lesser risk of embolisation?
gastrocs
Limitations of deep vein imaging of the calf? (3)
- obese patients
- severe edema
- acoustic windows in patients with open wounds/sutures
venous vs. arterial ulcers location in the calf?
- venous ulcers found in medial calf and ankle
- arterial ulcers found in lateral calf, ankle, toes
Common differential diagnoses identifiable on ultrasound are? (3)
- bakers cyst
- superficial venous thrombosis of varices and GSV/LSV
- calf muscle tears
patient position of deep vein imaging of the calf?
- recumbent with legs lower than torso
- seated with leg over bedside
what is a common varient seen in deep vein imaging of calf?
single deep calf vein instead of a pair
- will appear slightly larger than if paired
be cautious not to mistake what for the popliteal vein?
the gastrocnemius
