Venous

Question 1

What are the cutoff values in for duration of reflux in duplex of lower extremities?

Answer 1

1sec for Femoral and Popliteal veins

500ms for the other veins (Deep femoral, Saphenous, Tibial and perforator veins)

Question 2

What is the most appropriate treatment for post thrombotic syndrome with venous leg ulcer?

Answer 2

Debriding the ulcer and Compression therapy of 40-50mmHg stockings

Question 3

What are the CEAP classification?

Answer 3

classify the physical findings associated with chronic venous insufficiency.

Clinical
0 - No visible signs
1 - Telangiectasias or reticular veins
2 - Varicose veins
3 - Edema
4a - Pigmentation and/or eczema
4b - Lipodermatosclerosis and/or atrophy
5 - Healed venous ulcer
6 - Open venous ulcer
A - Asymptomatic
S - Symptomatic

Etiology
C - congenital
P - primary
S - secondary (post thrombotic)

Anatomy
S - superficial
P - Perforator
D - Deep

Pathophysiology
R - reflux
O - obstruction
R,O - reflux and obstruction
N - no venous pathophysiology identifiable

Question 4

What is the risk factor most associated with progression of CEAP clinical class of patients with varicose veins and chronic venous insufficirncy?

Answer 4

Prior deep vein thrombosis

Question 5

What are the typical swelling areas of the leg in venous insufficiency?

Answer 5

Swelling is limited to the foot and ankle.

Question 6

What should be considered if all the leg is swollen?

Answer 6

Venous outflow obstruction and/or lymphedema.

Question 7

What is the normal standing venous pressue?

Answer 7

90mmHg

Question 8

What is the normal venous pressure after exercise?

Answer 8

30mmHg

Question 9

how long does it take in a healhy person for the venous pressure (AVP test) to return to 90% of normal standing pressure after exercise?

Answer 9

30 seconds

Question 10

What is Ambulatory Venous Pressure test?

Answer 10

Gold standard for messuring venous hemodynamics.
Butterfly needle is placed in a dorsal pedal vein.
Baseline venous pressure is messured in standing.
10 tiptoe manuvers.
Recording of time to returen to 90% of baseline pressue.

25% with venous ulcers have normal AVP!!!

Question 11

What are optional resultes of AVP and their meaning?

Answer 11

Normal venous pressure - 90mmHg and fall to 30mmHg around exercise.

Pressure not fall normaly - Calf pump not working effectively.

Fast return to standing pressure - reflux of deep or superficial veins.

Pressure rise rather than fall - deep veins occlusion.

Question 12

What is Plethysmography test?

Answer 12

Noninvasive method of estimating changes in volume in an extremity and outflow. There are few diffecent methods but all messuring outflow.

Patients with normal outflow exhibit rapid emptying of their lower extremity veins.

Inflation of thigh pump to occlude outflow and fast deflation while messuring the venous pressure.
In normal subject (non occluded) the pressure drops fast to base line.

Question 13

What is the sensitevity of Plethysmography in detection DVT?

Answer 13

~90% above knee DVT and 66% and less below knee

Question 14

What is the rate of exsiting anterior accessory GSV?

Answer 14

anterior accessory GSV is the most common, found in

up to 14%

Question 15

How many vulves in the GSV and in the SSV?

Answer 15

Each of the veins have the same number of vulves which is 7-10.

Question 16

What is the rate of connection of SSV to SPJ within 5cm if the popliteal skin crease?

Answer 16

2/3

1/3 as high as 7cm above the crease.

Question 17

What is a reticular vein?

Answer 17

thin-walled venules (blue) lying in the superficial compartment with 1-3mm diameters.
May connect to the saphenous and create network called lateral subdermic venous system (LSVS) and may connect to telangietasias in 88% of patients.

Question 18

What is a Telangiectasias vein?

Answer 18

dilated venules (blue), capillaries, or arterioles (red) 0.1 to 1.0 mm in diameter.
Reticular veins are frequently “feeder” veins to
telangiectasias

Question 19

What is the Venous Clinical Severity Score (VCSS) and the Villalta scale?

Answer 19

Scoring systems that assess severity of disease and

quality-of-life issues.

Question 20

What is the primery point of primery and reccurent reflux in majority of patients?

Answer 20

SFJ mainly (~70%) and SSV (~20%).

Question 21

What are the most recommended treatments for saphenous reflux?

Answer 21

Both Radiofrequency ablation (RFA) and Endovenous laser ablation (EVLA) are safe and efficacious.

Question 22

What is the advantage of RFA and EVLA over open surgery and foam sclerotherapy?

Answer 22

“Success” rates were:
84% for RFA
94% for EVLA
78% for surgery
77% for foam sclerotherapy.

RFA and EVLA have less convalesce time, and decreased post procedural pain and morbidity.
They have more efficacy and cost-effective over sclerotheraphy.

Question 23

What are the complications of EVLA

Answer 23

DVTs, 0% to 5.7%
skin burns, less than 1%
nerve injury, 0% to 22%
superficial thrombophlebitis, 0% to 25%.

Rear complication (both EVLA and in RFA) is arteriovenous fistula, commonly occurring where the external pudendal artery crosses posterior to the GSV.