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RVT Review > Venous > Flashcards

Venous Flashcards

1
Q

Define Phlegmasia alba/cerulea dolens

A

Extreme form of iliofemoral DVT where swelling is so extensive the arterial circulation is compromised. Can lead to gangrene and limb loss.

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2
Q

What is the most dangerous complication of DVT?

A

PE

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3
Q

What is the most common complication of DVT?

A

venous insufficiency

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4
Q

Give five ways venous anatomy differs from arterial anatomy.

A 
thinner walls
flow direction
shape changes (circular to dumbbell) based on pressure
presence of valves
perforators
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5
Q

Name the leg perforators.

A

Perforators of the Femoral Canal
Peritibial Perforators
Posterior Tibial Perforators

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6
Q

What are the five Doppler characteristics of normal venous flow?

A

Spontaneous: flow exists in medium to large veins
Phasicity: velocity varies with respiration
Augmentation: confirms patency
Valsalva response: shows if valves are competent
Competency: unidirectional flow toward heart through valves, if not, reflux

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7
Q

What two methods are used in duplex examination of veins?

A

Compression/coaptation on short axis

Doppler evaluation on long axis

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8
Q

What is effort thrombosis? What is its other name?

A

Compression of the subclavian vein causing thrombosis.

Paget-Schroetter Syndrome

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9
Q

Thrombosis in the vein causes what sort of response?

A

Inflammatory - pain in first two weeks

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10
Q

What skin changes are noted with venous disease?

A 
Edema
Rubor from inflammatory process
Brawney color
Pallor - phegmasia alba dolens
Cyanosis - plegmasia cerulea dolens
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11
Q

What will lyse the thrombus? In what % of cases?

A

Plasminogen, in 20% of cases.

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12
Q

Describe the progression of DVT, in three stages.

A

Acute: first 2 weeks; hypoechoic, spongey, dilated, may have free floating tail, collaterals, active inflammation & pain
Subacute: weeks to 6 months: more hyperechoic, well adhered, may be dilated, collaterals
Chronic: bright, calcific, fibrous cords, retracted, wall thickening, sequelae occur

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13
Q

What are the risk factors for DVT?

A

Virchow’s Triad:

  • Stasis: ICU/CCU, bedrest, long ride, stroke
  • Trauma: surgery, accident
  • Hypercoaguable: cancer, pregnancy, dehydration, Protein C, Protein S, Factor V Leiden, Antithrombin 3 deficiency
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14
Q

Describe the difference between primary and secondary varicose veins.

A

Primary: limited to superficial system
Secondary: underlying deep venous incompetence and/or obstruction

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15
Q

Describe venous insufficiency.

A

Valvular incompetence (deep, superficial, or perforating) permits flow reversal (reflux), leading to venous HTN, venous claudication, ulcers, stasis dermatitis, etc.

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16
Q

What is VI caused by? (3)

A

Recanalized segments of thrombosed veins
Dilation of veins
Congenital absence of competent valves

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17
Q

List six sequellae of chronic VI.

A 
Edema
Fibrous deposits
Ulceration
Hemociterin - brawny appearance
Pain
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18
Q

What are the three goals of a venous exam for VI?

A

Determine the venous systems involved.
Determine the level.
Determine if VI is due to incompetence or obstruction or both.

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19
Q

What are the invasive tests for VI?

A

Venography, both ascending and descending. Ascending looks for DVT, descending looks for VI.
Ambulatory venous pressures: uses needle in foot for pressure readings.

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20
Q

What are the non-invasive tests for VI?

A

CW Doppler
Photoplethysmography (PPG) - infrared sensor, dorsiflexion. Refill time > 20 sec. is normal.
Air Plethysmography (APG)
Duplex: reversal .5–1.0 mild, > 1 significant

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21
Q

What does APG measure:

A

Is there VI?
Is there venous HTN distally?
Does the calf muscle work?

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22
Q

What is the duplex protocol for checking for VI?

A

• Evaluate for DVT
• Sample sites for VI/reflux: superficial and deep, B-Mode & Doppler
• Check perforators
Determines presence and location of VI and outflow obstruction.

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23
Q

What is the size at which perforators are probably incompetent?

A

> 4mm

24
Q

What are the advantages of Duplex exam for VI?

A

Specific localization in deep & superficial veins
Documentation of outflow obstruction
Identification of incompetent perforators

25
Q

What are the disadvantages of Duplex exam for VI?

A

Strength of augmentation is not standardized.
Time consuming.
Tech dependent.
Not well standardized.

26
Q

What are the mimics of DVT? (give 4)

A 
Venous congestion (excessive swelling from CHF, fluid overload)
Adenopathy (enlarged lymph nodes)
Abcesses
Hematoma
Soft tissue tumors
Popliteal cysts
Joint effusion (from knee injury)
Lymphedema
Lipoma
27
Q

What are the two types of heparin and their advantages/disadvantages?

A

Unfractionated: IV infusion, frequent complications

Low molecular weight: outpatient, belly injection, less monitoring, fewer complications

28
Q

When is heparin used?

A 
Pre-, intra, and post-op
Acute arterial occulsion
Angiography
DVT, PE, embolisms
Flushing
29
Q

What is HIT?

A

Heparin Induced Thrombocytopenia - clots in arteries and veins. Antibodies cause bleeding and/or formation of thrombus.

30
Q

When is Coumadin used?

A 
Outpatient:
  A-fib
  Post heparin for DVT, PE, etc.
  Prosthetic heart valve
  Coaguation disorders
31
Q

How is Coumadin monitored?

A

PT/INR

32
Q

List three thrombolytic agents.

A

Tissue Plasminogen Activator (tPA)
Urokinase
Streptokinase

33
Q

What are the medical treatments of STP?

A

Acute STP: ASA, elevation, hot soaks, compression socks.

34
Q

What are the medical treatments of DVT?

A

Acute DVT:
Prophylaxis: activity, compression boots, elevation, heparin, coumadin, ASA
Treatment: Heparin to Coumadin, Thrombolytics

35
Q

What are the medical treatments of Chronic VI?

A

Chronic VI: compression socks, elevation, Unna boots

36
Q

What are the surgical treatments of superficial venous disease?

A 
Sclerotherapy: injection into small varicosities or spider veins
Endovenous ablation (VNUS, ELVS)
Ligation, stripping
37
Q

What are the surgical treatments of acute DVT?

A

Thrombectomy (iliofem)
Vena caval interruption (filters)
Decompression of left iliac vein

38
Q

What are the surgical treatments of chronic VI?

A

Valve repair
Ligation of perforators
Linton: direct ligation of incompetent perfs through incision - ulcers repaired with skin graft
SEPS (Subcutaneous Endovascular Perforator System): perfs occluded with titanium clips endoscopically

39
Q

Distinguish between gastrocs and soleal veins.

A

Gastrocs: paired around artery, dumbbell shape, seen as they drain into pop
Soleal: single sinuses in soleal muscle, drain into PTs or peroneals - common site for thrombosis

40
Q

Most common variant in LE venous anatomy?

A

Bifed systems

41
Q

Patients with CHF usually have pulsatile venous Doppler signals in their legs - True or False?

A

True

42
Q

Acute venous thrombosis resolves completely in only what percent of cases?

A

20%

43
Q

What can be used to determine patency of the iliac veins?

A

Valsalva maneuver, with Doppler in CFV. Valsalva will stop flow, at release flow will continue. This shows valves are competent and veins patent.

44
Q

Name the membrane superficial to the PTs and Peroneals when examining the calf.

A

Soleal septum

45
Q

Name the membrane deep to the PTs and Peroneals when examining the calf (from the tibia to the fibula).

A

Interosseus membrane

46
Q

The confluence of which two veins forms the Axillary vein?

A

Basilic and Brachial veins.

47
Q

The confluence of which two veins forms the Subclavian vein?

A

Axillary and Cephalic veins.

48
Q

Is the left iliac vein anterior or posterior to the right iliac artery?

A

Posterior. Compression can cause thrombus formation in this vein.

49
Q

List four causes of lymphedema.

A

trauma
infection
inflammation
radiation and chemotherapy

50
Q

Symptoms of post-phlebitic syndrome?

A

pain (aching or cramping)
heaviness
swelling (edema)

51
Q

What is the cause of nephrotic syndrome?

A

Damage to the glomeruli.

52
Q

Define diaphoresis.

A

Profuse sweating.

53
Q

Two side effects of heparin.

A

Bleeding (hematoma)

Thrombocytopenia

54
Q

Symptoms of Pulmonary Embolism?

A 
Chest pain
Sudden cough
Tachypnea
Tachycardia
Shortness of breath
55
Q

Are venous ulcers painful?

A

Not usually.

RVT Review (5 decks)

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