Venous week pt. 2.

Question 1

What is abnormal in the brachiocephalic vein in regards to the waveforms?

Answer 1

Waveform’s non-phasic and/or non-pulsatile especially compared to the contralateral side.

Patient must be supine or central flow may lose pulsatility and spontaneity.

Question 2

What is abnormal in the brachiocephalic vein in regards to the velocity?

Answer 2

• Low velocity: partial or total occlusion
• High velocity: stenosis (rare)

Question 3

What is abnormal in the brachiocephalic vein in regards to the flow?

Answer 3

Retrograde flow in the interal jugular vein or subclavian vein are signs of proximal (BVC) obstruction.

Question 4

What do you do if you are mistaking a muscle for a SCV?

Answer 4

Look around for beggining or end of thrombus and check doppler distally.

Question 5

What is the collateral branch below the clavivle?

Answer 5

Thoracic vein.

Question 6

What are the signs of a thrombus?

Answer 6

1. incompressibility
2. Lack of color in multiple planes
3. No flow when sample volume placed within area of suspected collaterals.

Question 7

What doppler changes occur when a thrombus is completely occluding a vein?

Answer 7

1. No flow at area of thrombus
2. Doppler distal to occluded vein lacks pulsatility and phasicity

Question 8

What are some pitfalls?

Answer 8

• Poor identification of veins.
  
  • SCV is horizontal.
  • Mirrow image at SCV
• Cannot fully compress veins due to poor compression techniques
• Good collaterals may cause normal flow patterns distal to thrombus-BUT MUST SEE COLLATERALS TO CONFIRM THIS.
• Expect poor flow distal to a total occlusion unless multiple collaterals seen.

Question 9

What is the risk of PE from UE DVT?

Answer 9

Asymptomatic PE from UE dvt is less frequent than LE DVT.

0-25%

Question 10

What are some treatments for a UE DVT?

Answer 10

1. Rest/heat/elevation/external compression.
2. anticoagulation
3. Central venous catheter is removed.
4. Thrombolytic therapy.
5. Decompression of the thoracic outlet.
6. May useendovascular stent or venous reconstruction.

Question 11

What are the best UE venous scannig techniques?

Answer 11

• Must have the patient supine for central veins (BCV through AX V).
• Use color and B-mode even more carefully since central veins are hard to compress.
• If an UE vein is totally occluded, the distal doppler signal will be abnormal.
• If an UE vein is totally occluded, there will be swelling distal to that point.