Week 8 Flashcards
Locations:
proximal popliteal artery
Pop a
distal popliteal
above knee, distal thigh
crease
proximal part of calf
Do we leave color on as we look at the vessel? (after interrogating w/ 2-D)
Yes
In limbs affected by DVT _____% had at least one segment of incompetent vein
69
Varicose veins usually come from the superficial or deep venous system?
superficial
Gaiter area indicates
the most common area where venous ulcers occur
mid to distal calf
If a patient comes in with a palpable leg mass, consider:
thrombosed varicose vein
Read over reflux testing b/c it’s not good flashcard content
ok
Have to treat the varicose veins from the inside out. Why?
We have to treat (with heat) the cause/source. They’re a symptom of venous insufficiency, so we need to find the valves, once that’s closed they we can treat the varicose veins/spider veins (sclerosis therapy a month or so after and it’s multiple sessions)
There is no treatment for deep venous insufficiency, only superficial. True or false.
True, only thing we can do is treat symptoms with compression stalkings or elevation
What are the 3 main recurrence patterns for varicose veins (? i think, slide doesn’t say what this is for)
1- patent long saph vein may be present suggesting that it may be missed at the time of operation
2-small collateral veins along line of LSV may enlarge to reconstitute the path of vein
3- drainage can occur through venous collaterals which take a variety of courses remote from normal line of vein
What’s useful for the pattern of recurrence to decide on the appropriate surgical intervention?
CD
What are the 6 tributaries draining into the LSV at the level of the SFJ can be the source of primary/recurrent varicose veins?
superficial inferior epigatric vein** see this all the time deep external pudendal vein superficial external pudendal vein medial accessory saphv anterolateral thigh vein superficial circumflex iliac vein
Never (ever ever ever she said) perform a venous reflux on a patient with:
DVT
Terminal valve and subterminal valves will be seen at:
SFJ
What is the most convenient method to assess competent or incompetence of the venous segment?
squeeze calf or lower thigh
valsalva
When valsalva manuever is not effective, we use
augmentation. useful for popv and calf veins
Venous reflux is considered significant when it is longer than:
0.5s
Shorter periods of reversed flow may represent the valve cusps ______ ________.
coming together
Reflux should not be confused with
reversal of flow which occurs with turbulence– see this on spectral doppler as reverse and forward flow occuring at the same time
Can we augment with color Doppler?
Yes –if patient can’t tolerate exam any longer than we can quickly get something by using CD
Where is the most common location for an incompetent imperforating vein?
level of the junction of the mid and lower thirds of the thigh
Hunterian perforator
What’s the mid to distal thigh perforator vein called?
Hunterian perforator. Common location for varicose veins
Valsalva is reliable until where? What’s used after?
mid (sometimes distal) thigh.
compression
Varices should be traced _________ to identify the point of communication with deep or superficial segments.
proximally
Name the perforators:
soleus and gastrocneumius lateral ankle medial lower ankle Dodd's gastrocneumius Cockett
Perforators are greater in calf or knees?
Calves
Where is Dodd’s perforator located? Boyd’s? Cockett’s?
Dodds- inferior 1/3 of thigh
Boyd’s-knee level
Cockett’s- inferior 2/3 of leg (usually there are 3. Superior, medium and inferior perfs)
Perforator abnormal measurements:
> 3mm in calf
>4mm in thigh
What’s the preferred conduit for arterial bypass grafting in the coronary arteries and lower limb?
LSV
The measurement for vein mapping is taken in what plane?
Trv
What measurements should the vein be for a graft to be considered?
3-4 mm wide and >2mm at the ankle for a long femoral-distal graft
If an insitu lower limb arterial graft is to be performed, then perforating veins and superficial branches must be ligated to prevent an arteriovenous fistula from developing. True or false
True
Limitations and pitfalls for vessel mapping:
patient unable to stand body habitus and tolerance for compression bandages casts swelling
If leg veins aren’t good for mapping, they’ll use what veins?
Arm (basilic and cephalic)
Patients who have claudication only with exercise have an ABI of _____ prior to exercise, and ____to_____ following exercise.
1.0, 0.6-0.8
What does exercise cause in people with claudication?
temporary limb ischemia due to the diseased arterial tree’s inability to supply flow in increased flow requirements
Read the exercise testing steps
ok
A normal patient will show a slight decrease in pressure drop following an exercise test. True or false
False– no drop and in fact maybe a slight increase in pressure
How is the degree of arterial disease assessed?
by the magnitude of immediate pressure drop following exercise and the length of time required for the ankle pressure to return to the pre exercise level
Yea just read the exercise testing ppt cause not good flashcard content
but good info
People with pseudoclaudication should be evaluated for
MSK or neurospinal disorders
Normal patients criteria with reactive hyperemia:
return to pre-exercise levels within 30-60s
ankle pressure taken immediately after occlusion falls no more than 35% below resting level
Abnormal patients criteria with reactive hyperemia:
require >1minute to return to pre-exercise pressure levels
ankle pressure falls more than 35%
single level dx <50%
multi level dx >50%
