Vascular Ch. 18

Question 1

3 differences in protocol techniques for upper extremity and lower extremity

Answer 1

1. thrombi in lower extremity often caused by stasis: NOT SO IN THE UPPER EXTEMITY (NO SOLEAL SINUSES) 2. superficial veins affected more in arms than in legs 3. venous anatomy of upper extremity is more variable than lower extremity

Question 2

Why is thrombi in LOWER extremity often caused by stasis and not so in the upper extremity

Answer 2

no soleal sinus

Question 3

Does superficial thrombosis have greater clinical significance in arm than the leg

Answer 3

yes

Question 4

Facial swelling or dilated chest wall collaterals is suggestive of

Answer 4

superior vena cava thrombosis

Question 5

PE symptoms include

Answer 5

chest pain, tachypnea, tachycardia

Question 6

Why is upper extremity thrombosis more common

Answer 6

injury to vessel wall

Question 7

What causes injury to vessel wall in upper extremity

Answer 7

more frequent introduction of needles and catheters into arm veins

Question 8

What is PICC and does it cause thrombosis

Answer 8

peripherally inserted central catheter, yes

Question 9

Where is catheter inserted and positioned

Answer 9

through basilic or cephalic vein, positioned near right atrium

Question 10

What is paget-schroetter syndrome

Answer 10

venous thrombosis associated with compression of subclavian vein at the thoracic outlet

Question 11

Another name for Paget-Schroetter syndrome

Answer 11

effort thrombosis

Question 12

Typical patients of paget-schroetter syndrome

Answer 12

young, athletic, muscular males

Question 13

What position do you examine internal jugular and subclavian veins

Answer 13

lying flat, supine

Question 14

Why does the patient need to lay flat for IJV and subclavian vein

Answer 14

removes the impact of hydrostatic pressure which tends to collapse these veins

Question 15

Are compressions performed with brachiocephalic veins

Answer 15

no

Question 16

What is the landmark for the subclavian vein

Answer 16

the cephalic vein because it terminates into subclavian after it passes under clavicle

Question 17

Why should color and spectral doppler be documented for subclavian vein

Answer 17

most helpful to document patency and doppler signals will be both pulsatile and phasic

Question 18

In the cephalic vein, thrombus at this level will have

Answer 18

the same gray scale appearance as thrombus within the brachial vein

Question 19

Normal vein walls will ______ with transducer pressure

Answer 19

completely compress (performed in transverse)

Question 20

In diagnosis, normal vein walls should be

Answer 20

smooth, thin, anechoic vessel lumen

Question 21

What changes SLIGHTLY with respiration

Answer 21

vein diameter

Question 22

Superficial vein thrombus will have same appearance as

Answer 22

DVT

Question 23

What is the appearance of superficial vein thrombosis

Answer 23

hypoechoic areas may be present around vein due to inflammation

Question 24

_______ forming around a catheter may cause doppler signals to ________

Answer 24

nonocclusive thrombus, become continuous

Question 25

Spectral doppler waveforms should demonstrate

Answer 25

respiratory phasicity, augmentation with distal compression, and pulsatility (common near heart)

Question 26

What vessels may have pulsatility

Answer 26

IJV, subclavian and brachiocephalic veins

Question 27

Color and spectral doppler flow for COMPLETE thrombus

Answer 27

no signal or color filling will be obtained

Question 28

What may result in continuous flow

Answer 28

partial thrombus, proximal thrombus, extrinsic compression

Question 29

What are commonly encountered in the arm

Answer 29

indwelling venous catheters

Question 30

How do catheters appear within vessel lumen

Answer 30

bright, straight, parallel echoes

Question 31

How does thrombus appear around catheters surface

Answer 31

echogenic material

Question 32

Spectral doppler with venous catheter

Answer 32

diminished and/or continuous

Question 33

Treatment considerations for thrombus around catheter

Answer 33

anticoagulation, catheter removal, thrombolytic therapy

Question 34

Upper extremity veins may not be compressible at every level due to their course ______, but should be compressed when possible

Answer 34

behind bones

Question 35

Doppler is even more vital in evaluation when

Answer 35

compression is not possible

Question 36

Which is true regarding thrombus in the legs

Answer 36

more in arms

Question 37

What frequently causes thrombus in upper extremity

Answer 37

injuries to vessel walls

Question 38

Venous thrombus associated with compression of subclavian vein at the thoracic outlet

Answer 38

paget-schroetter syndrome

Question 39

Landmark for axillary

Answer 39

cephalic vein

Question 40

What is normally most helpful to document patency in subclavian vein

Answer 40

color and spectral doppler

Question 41

All of the following are normal grayscale findings except

Answer 41

hyperechoic

Question 42

Hyperechoic tissue adjacent to thrombus in superficial vein due to

Answer 42

inflammation

Question 43

IJV and subclavian veins examined with patient lying flat

Answer 43

potentially collapse, removed impact from hydrostatic pressure

Question 44

Catheters appear as

Answer 44

bright, straight, parallel echoes within vessel lumen

Question 45

Thrombus in the cephalic vein has same gray scale appearance as thrombus in

Answer 45

brachial vein

Question 46

Doppler should be symmetrical

Answer 46

can’t compress it

Question 47

Nonocclusive thrombus forming around catheter may cause

Answer 47

doppler signal to become continuous

Question 48

What are the 5 treatments for venous catheters

Answer 48

anticoagulants, catheter removal, thrombolytic therapy, conservative treatment, surgical compression of thoracic inlet with or without venous reconstruction

Question 49

3 upper extremity vessels with pulsatility

Answer 49

IJV, subclavian, brachiocephalic