Week 8

Question 1

Locations:
proximal popliteal artery
Pop a
distal popliteal

Answer 1

above knee, distal thigh
crease
proximal part of calf

Question 2

Do we leave color on as we look at the vessel? (after interrogating w/ 2-D)

Answer 2

Yes

Question 3

In limbs affected by DVT _____% had at least one segment of incompetent vein

Answer 3

69

Question 4

Varicose veins usually come from the superficial or deep venous system?

Answer 4

superficial

Question 5

Gaiter area indicates

Answer 5

the most common area where venous ulcers occur

mid to distal calf

Question 6

If a patient comes in with a palpable leg mass, consider:

Answer 6

thrombosed varicose vein

Question 7

Read over reflux testing b/c it’s not good flashcard content

Answer 7

ok

Question 8

Have to treat the varicose veins from the inside out. Why?

Answer 8

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)

Question 9

There is no treatment for deep venous insufficiency, only superficial. True or false.

Answer 9

True, only thing we can do is treat symptoms with compression stalkings or elevation

Question 10

What are the 3 main recurrence patterns for varicose veins (? i think, slide doesn’t say what this is for)

Answer 10

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

Question 11

What’s useful for the pattern of recurrence to decide on the appropriate surgical intervention?

Answer 11

CD

Question 12

What are the 6 tributaries draining into the LSV at the level of the SFJ can be the source of primary/recurrent varicose veins?

Answer 12

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

Question 13

Never (ever ever ever she said) perform a venous reflux on a patient with:

Answer 13

DVT

Question 14

Terminal valve and subterminal valves will be seen at:

Answer 14

SFJ

Question 15

What is the most convenient method to assess competent or incompetence of the venous segment?

Answer 15

squeeze calf or lower thigh

valsalva

Question 16

When valsalva manuever is not effective, we use

Answer 16

augmentation. useful for popv and calf veins

Question 17

Venous reflux is considered significant when it is longer than:

Answer 17

0.5s

Question 18

Shorter periods of reversed flow may represent the valve cusps ______ ________.

Answer 18

coming together

Question 19

Reflux should not be confused with

Answer 19

reversal of flow which occurs with turbulence– see this on spectral doppler as reverse and forward flow occuring at the same time

Question 20

Can we augment with color Doppler?

Answer 20

Yes –if patient can’t tolerate exam any longer than we can quickly get something by using CD

Question 21

Where is the most common location for an incompetent imperforating vein?

Answer 21

level of the junction of the mid and lower thirds of the thigh
Hunterian perforator

Question 22

What’s the mid to distal thigh perforator vein called?

Answer 22

Hunterian perforator. Common location for varicose veins

Question 23

Valsalva is reliable until where? What’s used after?

Answer 23

mid (sometimes distal) thigh.

compression

Question 24

Varices should be traced _________ to identify the point of communication with deep or superficial segments.

Answer 24

proximally

Question 25

Name the perforators:

Answer 25

``` soleus and gastrocneumius lateral ankle medial lower ankle Dodd's gastrocneumius Cockett ```

Question 26

Perforators are greater in calf or knees?

Answer 26

Calves

Question 27

Where is Dodd's perforator located? Boyd's? Cockett's?

Answer 27

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)

Question 28

Perforator abnormal measurements:

Answer 28

>3mm in calf | >4mm in thigh

Question 29

What's the preferred conduit for arterial bypass grafting in the coronary arteries and lower limb?

Answer 29

LSV

Question 30

The measurement for vein mapping is taken in what plane?

Answer 30

Trv

Question 31

What measurements should the vein be for a graft to be considered?

Answer 31

3-4 mm wide and >2mm at the ankle for a long femoral-distal graft

Question 32

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

Answer 32

True

Question 33

Limitations and pitfalls for vessel mapping:

Answer 33

``` patient unable to stand body habitus and tolerance for compression bandages casts swelling ```

Question 34

If leg veins aren't good for mapping, they'll use what veins?

Answer 34

Arm (basilic and cephalic)

Question 35

Patients who have claudication only with exercise have an ABI of _____ prior to exercise, and ____to_____ following exercise.

Answer 35

1.0, 0.6-0.8

Question 36

What does exercise cause in people with claudication?

Answer 36

temporary limb ischemia due to the diseased arterial tree's inability to supply flow in increased flow requirements

Question 37

Read the exercise testing steps

Answer 37

ok

Question 38

A normal patient will show a slight decrease in pressure drop following an exercise test. True or false

Answer 38

False-- no drop and in fact maybe a slight increase in pressure

Question 39

How is the degree of arterial disease assessed?

Answer 39

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

Question 40

Yea just read the exercise testing ppt cause not good flashcard content

Answer 40

but good info

Question 41

People with pseudoclaudication should be evaluated for

Answer 41

MSK or neurospinal disorders

Question 42

Normal patients criteria with reactive hyperemia:

Answer 42

return to pre-exercise levels within 30-60s | ankle pressure taken immediately after occlusion falls no more than 35% below resting level

Question 43

Abnormal patients criteria with reactive hyperemia:

Answer 43

require >1minute to return to pre-exercise pressure levels ankle pressure falls more than 35% single level dx <50% multi level dx >50%