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Vascular Sonography > Venous Ch 24-33 > Flashcards

Venous Ch 24-33 Flashcards

1
Q

Difference between the pressure within the vein (intramluminal pressure) and from outside the veins (interstitial pressure)

A

transmural pressure

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2
Q

the venous system holds _____ of total blood volume

A

two-thirds

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3
Q

veins can distend ____ times that of the coresponding artery.

A

3-4

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4
Q

The greater resistance occurs when the vein is ________ and the least resistance exists when the vein is _________

A

elliptical, distended

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5
Q 
supine = \_\_\_\_\_ transmural pressure 
Standing = \_\_\_\_\_ transmural pressure
A

low

high

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6
Q

is caused by the weight of a column of blood extended from the heart to the level where the pressure is being measured

A

hydrostatic pressure

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7
Q

hydrostatic pressure = _ x _x _

A

p,g,h
p= blood density (specific gravity of blood)
g= acceleration due to gravity
h= height of the column of blood (distance from the heart)

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8
Q

hp at the ankles

A

100mmHg (ankle P = circulatory + 100mg)

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9
Q

arm pressure =

A

venous P - 50mmHg

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10
Q

during inspiration…

A
  • pressure decreases in chest
  • increased abdominal pressure
  • IVC collapses and venous return from the legs is impeded
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11
Q

during expiration…

A
  • abdominal pressure decreases
  • pressure increases in chest
  • flow increases from legs into abdomen
  • blood flow is decreased into the thorax
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12
Q

valsalva maneuver causes the intrathoracic and intraabdominal pressure to ….

A

increase significantly
all venous return is halted
the maneuver equates with proximal compression while preforming doppler assessment of the lower extremities

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13
Q

Normal time when testing for venous reflux*

A

Normal 1 sec

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14
Q

In the past, the clinical diagnosis of acute DVT based on pt medical history and physical exam was considered _________ (___%)

A

very unreliable, less than or equal to 50%

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15
Q

most common clinical findings of ACUTE DVT

A
  • swelling
  • pain
  • redness, or erythema
  • warmth
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16
Q

nonspecific test for deep venous disease since any inflammation of muscle will elicit the same result

A

Homan’s sign

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17
Q

symptoms of CHRONIC DVT…

A
  • swelling
  • erythema
  • heaviness/aching
  • discoloration or ulcerations
  • varicosities
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18
Q

CEAP is the international standard for describing clinical manifestations and pathologic features of chronic venous disease

A 
C = Clinical disease
E= Etiology
A= Anatomic distribution of reflux
P= underlying Pathology
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19
Q

the development of venous thrombosis is based on three factors know as __________

A

VIRCHOW’S TRIAD***

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20
Q

what are the three factors in Virchow’s Triad?***

A
  • trauma to the vessel
  • venous stasis
  • hypercoagulability
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21
Q

thrombosis usually occurs at the most _______ portion of the PICC line

A

proximal

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22
Q

what can cause venous stasis?

A
  • bed rest or immobility
  • CHF
  • obesity
  • COPD
  • pregnancy
  • previous DVT
  • extrinsic compression
  • surgery-associated condition
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23
Q

what can cause hypercoagulability?

A
  • cigarette smoking
  • brith control pills
  • estrogen intake
  • cancer
  • pregnancy
  • inherited states, e.g. factor V leiden etc.
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24
Q

also known as stress or effort thrombosis
-usually involves thrombosis of the subclavian or axillary vein secondary to intense, repetitive activity
-venous component of TOS
Ex. heavy lifting or strenuous throwing of base ball or football

A

Paget-Schroetter Syndrome***

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25
left common iliac vein compression by the right common iliac artery as the artery crosses over it.
May-Thurner Syndrome***
26
what is Nutcracker syndrome?
compression of the left renal vein between the aorta and the SMA
27
hypoplatic or complete absence of the deep veins (absent iliacs with varicosities of the superfical system resulting in a enlarged limb
Klippel-Trenaunay
28
in klippel-Trenaunay severe varicose veins, widely dispersed, are commonly seen on the _______ aspect of the thigh and calf.
lateral
29
causes of portal hypertension
- chronic liver disease such as cirrhosis - severe CHF - proximal venous occlusion
30
most common symptom of Superior Vena Cava Syndrome
- dysonea (difficulty breathing) is most common | - facial and extremity swelling may also be evident
31
most common solid renal mass in adults that can result in thrombosis of the renal vein.
Renal Cell Carcinoma
32
most common cause of IVC tumor
Renal Cell Carcinoma
33
secondary varicose veins are a result of ...
constructive conditions | value damage from DVT, pregnancy, obesity
34
thickening or hardening of the skin and can be found in pt with chronic venous insufficiency
lipodermatosclerosis
35
What is "bottle-neck-deficiency" ?
over time tissue becomes depressed, changing the contour of the ankle area
36
limb threatening condition that results from arterial spasms that occur secondary to extensive, acute ilio-femoral vein thrombosis; Limb is very swollen, pale, and painful whiteness (pallor)
phegmasia alba dolens
37
complications of an acure iliofemoral vein thrombosis severely reduced venous outflow causes marked reduction in arterial inflow tissue hypoxia can develop, leading to venous gangrene limb is very swollen, dark blue, and painful limb threatening!
plegmasia cerulea dolens
38
1st stage- phegmasia alba dolens and 2nd stage- plegmasia cerula dolens are both examples of an ______
acute DVT
39
the formation of local defects on the surface of skin that occurs with the sloughing of inflammatory necrotic tissue - can be associated with venous disease
ulceration
40
where do venous ulcers usually occur?
around the medial malleolus where the posterior tibial (formerly Cockett's I, II, and III) perforators are located
41
one of the most consistent signs of elevated venous pressure
edema
42
documents capillary blood volume, evaluates the presence and severity of venous insufficiency (microcirculation)
PPG
43
how is the pt positioned for a PPG?
seated with legs dangling, i.e. nonweight bearing | sensor is placed on the lower leg, 5-10cm above the medial mallelous
44
speed of the strip chart recorder for PPGs
5mm/sec
45
technique used for PPGs
- pt is instructed to dorsiflex the foot 5 times to empty veins - tracing is recorded after dorsiflexions to record venous refill time or venous reactive time (VRT)
46
normal venous reactive time...
greater than or equal to 20 sec***
47
If VRT is less than ______ sec the study is repeated with a tourniquet test to determine if the incompetence is coming from the superficial or deep system
20
48
VRT of less than 20 sec without the tourniquet that normalizes to greater than 20 sec with the touriquet ABOVE THE KNEE is consistant with reflux in the ....
great saphenous
49
VRT of less than 20 sec without the torniquet that normalizes to greater than 20 sec only when the tourniquet is applied BELOW THE KNEE is consistant with reflux in the .....
small saphenous
50
a VRT of less than 20 sec with and without tourniquet application is consistent with....
reflux in the deep system
51
Normal VFT is _____, minor to moderate reflux is _____, and severe reflux is _____
less than or equal to 2, greater than 2-10, greater than 10
52
normally want the ejection fraction a high percentage, Normally the calf expels _____ with one toe up
greater than 60%
53
a residual volume fraction of _____ is considered normal
less than 35%
54
reverese trendelenbury is approx. ____ degrees
30
55
continuous wave doppler ___MHz at _____ degrees
5, 45-60
56
continuous wave interpretation
-spontaniety, patency, respiration/phasicity
57
continuous flow patterns of veins of the upper or lower extremity are usually consistent with ______ venous obstruction
proximal
58
most common duplications
-femoral and popliteal vein
59
when identifying venous insufficiency a _____cm cuff is is applied to the high thigh portion of the leg the cuff is then inflated to ____mmHg and maintained for ____ seconds
12x40 80 1-2
60
the cuff is inflated to ____mmHg for the popliteal vein and placed on the calf
100
61
for the posterior tibial vein the cuff is inflated to _____mmHg
120
62
how can you optimize the system for low velocity flow detection
- decrease scale - decrease wall filter - increase color gain
63
- largest vein in the upper arm | - medial and superficially without an companion artery
basilic vein
64
if a perforator vein has a diameter of ____mm, many think its probably normal regardless of flow direction
less than 3
65
if a pt has a dialysis accsess graft what should be expected
- increased velocity and volume flow - pulsatile flow - no response to distal compression - incompressible vessel - collateral channels evident
66
sluggish flow seen as heterogenous material moving with respirations and augmentation maneuvers -red blood cells arrange like a roll of coins or roleau
roleau formation
67
a compressible vessel with evidence of roleau formation on b-mode suggest ______ obstruction
proximal
68
if the perforator measures greater than 3,5mm reflux has been found to be present about ____ of the time
90%
69
two alternative diagnostic tests related to venous diseases
- D-dimer | - contrast venography (used to evaluate pulmonary embolism)
70
proteins produces when a blot clot dissolves in the body and normally is undetectable in the blood.
D-dimer
71
considered the "gold standard" | the number has decreased due to the accuracy of duplex scanning
contrast venography
72
the most common cause of varicose veins is imcompentence of the _______ vein
great saphenous
73
used to treat small varicosities such as spider veins
sclerotherapy
74
primary treatment of non healing ulcers
unna boots
75
- fistula in the non dominate arm | - radial artery to cephalic vein fistula is most common
Brescia-Cimino Fistula
76
grafts are usually made of _____ commercially known as _____
teflon , Gore Tex
77
requirments for AVF and grafts
- venous diameter is greater than or equal to 2.5mm - for a graft the vein should be greater than or equal to 4mm - within 1cm of the skin surface

Vascular Sonography (8 decks)

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