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Vascular sonography
Test 3 Lower Extremity Venous Protocol and Scanning
| Question | Answer |
|---|---|
| What is the method of choice for imaging DVT? | Duplex Ultrasound |
| What can Duplex ultrasound be used for when imaging DVT? | Can be used to diagnose, localize, and determine the age of the thrombus, and it can uncover vascular & non-vascular incidental findings |
| Is Duplex ultrasound very sonographer dependent? | YES, proper training and following standardized protocol is very important |
| What is Duplex ultrasound used to assess? | Presence or absence of thrombus, Relative risk of thromboembolism, Competence of contained veins |
| What does a venous thromboembolism consist of? | Venous Thrombosis and Pulmonary Embolism |
| More than _______ cases of DVT each year in the United States | 500,000-600,000 |
| Out of the 500,000-600,000 cases of DVT in the US, what percent goes unrecognized? | More than 50% |
| Approximately how many cases of fatal Pulmonary Embolism are there annually? | 200,000 |
| What is PE a complication of? | Complication of a DVT |
| what is PE a leading cause of? | Preventable death |
| What is also a significant concern when dealing with DVT? | Post-thrombotic syndrome, a chronic condition carries significant morbidity (pain, welling, ulcers) |
| What commonly begins around valve cusps? | Venous Thrombi |
| What is VEnous Thrombi? | Areas of slower blood |
| Stagnation leads to what? | Coagulation |
| A small thrombi can develop into what? | A large Thrombi |
| What does Virchow's Triad represent? | Represents the primary mechanism for formation of venous thrombus |
| What does Virchow's Triad include? | Includes: Venous Stasis, Vessel wall injury, and Hypercoagulable state |
| What is the formation of a thrombosis determined by? | Determined by imbalance of clotting factors, Coagulation inhibitors, and Fibronolytic system |
| What allows for increased exposure to clotting factors? | Venous Stasis |
| What affects the body's normal thrombolytic system and is a result of injury or trauma? | Vessel Wall Injury |
| What is associated with various diseases (cancer) or medications such as birth control pills, or hormone replacement therapy, and genetic factors also play a role? | Hypercoagulability |
| What are the risk factors for DVT? | Age, Surgery/Trauma, Immobilization, Hx or DVT, Coagulation disorders- congenital/acquired, Malignancy, Septicemia, BCP, HRT, Pregnancy, Obese, Stroke, CHF, Long distance travel, IBD, Varicose veins |
| What is BCP? | Birth Control Pills |
| What is HRT | Hormone Replacement Therapy |
| What is IBD? | Inflammatory Bowel Disease |
| What is DVT related to? | Related to venous obstruction, vascular inflammation, and embolization of thrombi |
| True/False: Many patient's are asymptomatic with DVT? | True |
| When symptoms are present with DVT what will they include? | Extremity pain, tenderness, swelling, venous distension, discoloration, palpable cord |
| What are some Pulmonary Embolus sumptoms? | Tachypnea, Chest Pain, and Tachycardia |
| What should you remember when obtaining relevant Hx of patient? | Important to ask about Virchow's Triad |
| What type of TD will be used for scanning Lower extremity Venous? | 5.0-7.5 MHz |
| What position should the bed be in for a lower extremity venous exam? | Reverse Trendelenburg Position |
| What does the reverse trendelengurg position do to veins? | Reverse trendelenburg allows veins to fill with blood, making them easier to visualize |
| Where can you place the patient's legs to help visualize calf veins better? | Dangle legs off side of the bed |
| Where does the lower extremity venous exam being? | Begins at groin |
| Exams of peripheral veins requires what? | Transducer compressions |
| How far apart should compressions be performed going down the leg? | Every 2-3 cm |
| After transverse images with compressions are completed, the veins can be evaluated in a _____ plane? | Longitudinal |
| What is NEVER performed in long? | Compressions |
| What should be assessed during longitudinal scanning of lower extremity venous? | Spontaneity, phasicity with respiration, augmentation with distal compression, and cessation of flow with proximal compression |
| What lies next to the Common Femoral Artery just below the inguinal ligament? | Common Femoral Vein |
| What enters the common femoral vein at the saphenofemoral junction? | Great Saphenous Vein |
| What is the longest vein in the body? | Great Saphenous Vein |
| Where does the Great Saphenous Vein travel? | close to the skin in the saphenous compartment, courses medially & superficially to the CFV, and becomes more anterior blow the knee |
| Vessels should be what? | Patent |
| What does Patent mean? | Open |
| What type of veins will compress completely with transducer compressions? | Thrombus free veins |
| What MUST touch each other during compressions? | The vein walls |
| How should vein walls appear? | Thin and smooth |
| What may appear as slight dilations of veins? | Vein sinuses |
| What may appear as thin white structures within the sinus, and they move freely | Valve leaflets |
| What forms the Common Femoral Vein? | The junction of the Femoral Vein and the Deep Femoral Vein |
| How far down should the Femoral Vein be evaluated? | In it's entirety through the thigh |
| What is the main venous outflow of the calf? | The Femoral Vein |
| Where is the Deep Femoral Vein evaluated? | The DFV evaluation is usually limited to Proximal CFV |
| What does the Deep Femoral Vein drain? | The thigh |
| In the thigh the Femoral Vein may be what? | Bifid, each vessel may be evaluated, and one vessel may be normal while the other is thrombosed |
| Where does the Femoral Vein travel? | FV travels deep in the distal thigh, into muscles of the thigh |
| The Femoral Vein distal to the adductor canal becomes the what? | Popliteal Vein |
| What is the main drainage from the calf? | The Popliteal Vein |
| In the upper level of the Popliteal fossa what can be seen? | The Popliteal Vein and Artery |
| In the lower level of the Popliteal fossa what can be seen? | The Gastrocnemius branches may be seen |
| The Popliteal may also be what? | Bifid |
| What is the superficial vein that terminates into the Popliteal Vein (Saphenofemoral junction), it may also terminate into the Femoral Vein or even the Great Saphenous Vein | The Small Saphenous Vein |
| The extension of the Small Saphenous Vein above the Popliteal fossa is called what? | The Vein of Giacomini |
| Where does the SSV course? | Courses along the middle of the posterior calf |
| Where does the SSV receive tributaries from? | The medial and lateral calf |
| What are Gastrocnemius Veins? | Small tributaries that join into the Popliteal Vein, Drain the Gastrocnemius muscles, Paired veins with accompanying artery |
| Are Gastrocnemius veins major deep veins of the calf? | NO |
| What is the major storage area for blood in the calf? | Soleal Sinus Veins |
| What is a common site of thrombus formation? Why? | Soleal Sinus Veins, because Blood only moves out when calf muscles contract, Prone to thrombus formation due to stagnation, communicate with PTV's and Pero V's, Thrombus can extend into deep system |
| What does the Anterior Tibial Vein terminates into? | Terminates into the Popliteal Vein in the mid to upper Popliteal fossa |
| Why may ATV's be difficult to visualize on ultrasound? | Due to the depth and angle of the termination |
| Are ATV's paired in the calf, forming one single trunk before joining the Popliteal Vein? | YES |
| Is imaging of ATV included in most protocols ? | No, because a thrombosis is rare |
| What is the Tibioperoneal Trunk formed from? | Formed from Posterior Tibial and Peroneal Veins |
| The Tibioperoneal Trunk joins with the ATV to form what? | The Popliteal Vein, forms in the distal Popliteal fossa |
| What merge together to form the Tibioperoneal Trunk? | The common Posterior Tibial and the common Peroneal trunks, Formed from paired Posterior Tibial and Paired Peroneal Veins, The length is variable |
| Where do Posterior Tibial Veins course? | Course medially in calf near Tibia |
| Are PTV's paired veins with accompanying PTA? | YES |
| Where do the PTV's arise from? | Arise from tributaries between medial mallelous and Achilles tendon |
| Do Peroneal Veins course deeper in the calf adjacent to the Fibula? | YES |
| Are Peroneal Veins paired with accompanying Peroneal Artery? | YES |
| Where do Peroneal Veins arise from? | Lateral Mallelous |
| Are Iliac Veins usually scanned? | Not usually scanned unless clinical indication to suggest involvement |
| Does the Doppler signal at the CFV provide indirect assessment of the Iliac Veins? | YES |
| Phasic flow at the CFV suggest lack of what? | Obstruction (proximal) |
| The imaging in the pelvis and abdomen are complicated by what? | The depth of vessels, overlaying bowel gas and the inability to compress vessels, MUST rely on color and spectral Doppler |
| The External Iliac Vein is a continuation of the what? | Common Femoral Vein |
| What forms the Common Iliac Veins? | The Internal Iliac vein joins the External Iliac vein at the level of the sacroiliac joints to form the common iliac veins |
| What do the Common Iliac Veins join together to form? | The IVC |
| What are some technical considerations and pitfalls of imaging lower extremity venous? | Caution with compression in the presence of thrombosis, Limited visualization due to body habitus, Deep calf veins can be hard to see and hard to compress, &The presence of wounds, dressings, orthopedic hardware & surgical incisions make it hard to see |
| What can color flow be helpful for? | Help visualize venous anatomy, Assists w/ following course of vessel, Demonstrate if thrombus is present or occlusive, |
| What should you do to the Doppler scale, gain and filter for venous flow? | Optimize it |
| Doppler signal should display the following (normal findings): | Spontaneous Doppler signals in all major vessels, Respiratory Phasicity, Augmentation with distal compression, Cessation of flow after Valsalva Maneuver (or prox compression), & Flow should be unidirectional toward heart |
Created by:
EmilyGriffin
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