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Adv. Vas. Son.
Test 1 venous imaging and insufficiency
| Question | Answer |
|---|---|
| What are the symptoms of venous insufficiency? | Recurrent calf/ankle/foot swelling, Varicosities |
| What are some varicosities? | Varicose veins-palpable, distended veins of >4mm in dia. Spider veins, Reticular veins, Venous claudication, Stasis dermatitis, Ulceration, Chronic limb swelling(edema) |
| What are spider veins also known as? | Telangiectasias |
| What are reticular veins? | Subdural veins 1-4mm |
| Where is the Small Saph vein? | Posterior aspect of the calf, Typical confluence is at the Pop vein |
| In 20-30% of the population SSV will enter above the popliteal vein, what is this known as? | Vein of giacomini |
| Does the SSV have an adjacent artery? | Nope |
| What are perforator veins? | Go from superfical to deep, they have valves that prevent the blood from deep to superficial |
| How many venous valves do the IVC, EIV, and CIV have? | 0 ZERO |
| How many venous valves does the CFV have? | 1 ONE |
| How many venous valves does the FV have? | 4 FOUR |
| How many venous valves does the POP have? | 2 TWO |
| How many venous valves do the PTV, PER, and ATV have? | 10 TEN EACH |
| How many venous valves do the Perforators have? | 1 ONE |
| How many venous valves does the GSV have? | 12 TWELVE |
| What are the 4 different venous protocols? | Acute DVT protocol. Venous Insufficiency protocol. Pre-ablation protocol. Vein mapping for arterial bypass protocol |
| What are the steps for Protocol #2 Venous insufficiency? | R/O chronic DVT. Reflux test of deep veins. Identify reflux in GSV and SSV. Identify incompetent perforators |
| What can cause venous insufficiency? | Chronic outflow obstruction |
| There is no chronic outflow obstruction if: | CFV and Pop Vs are compressible, and If respiratory phasic flow is present @ Pop V |
| How do you evaluate vein competency? | Spectral doppler (quantitative), Color (qualitative), Valsalva(or prox limb compression), Following distal limb compression |
| Reflux is abnormal _____ seconds for deep veins? | ≥1.0 seconds |
| What is the abnormal reflux time with a standing PT for the Deep veins? | ≥ 1.0 seconds |
| What is the abnormal reflux time with a standing PT for the GSV & SSV? | ≥ 0.5 seconds |
| What is the abnormal reflux time with a standing PT for the Perforators? | ≥ 0.35 seconds |
| What is the distribution of valvular incompetence in venous stasis ulcers? D=deep, S=superficial, &P=perforators | D only=2.1%, P only=8.4%, S only= 16.8%, S&D=11.6%, P&D=4.2%, S&P=19.0%, and S&P&D=316% |
| Most patients with serve symptoms of insufficiency (ulcers) have what incompetence? | Multiple system incompetence |
| How do you determine if the superficial system is incompetent? | Eval entire GSV for reflux. Eval SSV only if it's large & dilated. Eval perforating veins (if distended) |
| What are the GSV diameters consistent with reflux? Where? | SFJ >9.0mm, Mig thigh> 7.0mm, Mid calf> 5.0mm |
| Theoretically what is the best reflux test position for the PT? | Standing |
| When should you assess the Small Saph Vein? | If it's large, If there are associated varicosities, Look for reflux following calf augment |
| What % of incometent Perforator veins are ≥35mm? | 90% |
| What are the vein abalation (closure) procedures? | Laser (EVLT). Radiofrequency (NVUS). Sclerosing foam injection |
| Describe the radiofrequency method: | Catheter inserted in refluxing vein. Catheter positioned, elctrodes displayed. RF energy heats & contracts vein wall. Catheter slowly withdrawn, closing vein. Denuded vein is physically narrowed |
| What is SSV Tumescence? | Creates a "heat sink" around the vein to dissipate heat, orevents skin burn, numbs the region, & compresses the vein around the catheter(lidocaine/saline fluid around the catheter in compressed vein) |
| For SSV tumescence where do you measure the GSV? | GSV @ origin, Mid lower, and thigh |
| Radiofrequency venous closure is limited to veins _______ in diameter: | 2-14 mm |
| Review: What is protocol #1 for? | Acute DVT |
| Review: What is protocol #2 for? | Venous Insufficiency |
| Review: what are the steps for Protocol #2? | Step 1= Chronic outflow obstruction? Step 2= Incompetent deep veins? Step 3= Incompetent superficial veins? Step 4= Incompetent perforators? |
| Review: What is Protocol #3? | Pre-op evaluation for vein ablation (may include vein mapping) |
| What is the Internation Standard for clinical manifestations for CV disease? | C=Clinical, E=Etiology, A= Anatomic, P= Pathophysiologic |
| C0 stands for? | No venous insufficiency signs or symptoms |
| C1 stands for? | Telangiectasias &/or reticular veins (<3mm) |
| C2 stands for? | Varicose veins (≥3mm) |
| C3 stands for? | Edema |
| C4 stands for? | Skin changes and that's divided into C4a & C4b |
| C4a stands for? | Minor skin changes |
| C4b stands for? | Major skin changes, such as lipodermatosclerosis |
| C5 stands for? | Healed skin ulcers |
| C6 stands for? | Open skin ulcers |
| What is used as a screening procedure for detection of reflux, but it can't determine the source? | Venous Photoplethysmography |
| What does PPG emit? | Infrared light and detects signal reflected back from cutaneous vessels |
| Diagnosis criteria: | Venous recovery time or refilling time (VRT) is usually measured. NORMAL >20 seconds. Reflux is suspected with refill times <20 seconds. SEVERE reflux time is <10 seconds |
| VRT <20 secs without and >20 seconds with tourniquet suggests what? | Superficial Disease |
| VRT <20 seconds with and without tourniquet suggests what? | Deep Disease |
Created by:
EmilyGriffin
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