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Vascular sonography
Test 3 anatomy, hemodynamics, and physical exam
| Question | Answer |
|---|---|
| what forms the common iliac vein? | External and internal iliac veins |
| What does the common iliac vein drain? | Legs and pelvic organs |
| The Left common iliac vein passes beneath the _______ at the level of the __________ | beneath the right common iliac Artery at the level of the aortic bifurcation |
| What forms the IVC? | Left and Right common iliac veins |
| IVC courses through the ______, to the right of the _____ | through the abdomen, to the right of the aorta |
| Which leg has a higher risk for DVT, and why? | Left leg. and because the LCIV passes beneath the RCIA |
| What are the main conduits for blood returning to the heart? | Deep veins |
| Deep veins will have what? | An accompanying artery of the same name |
| What are paired veins in the lower leg (calf) called? | Venae Comitantes |
| Why are deep veins at a higher risk for embolism? | Due to squeezing actions of leg muscles |
| A thrombus in the deep system is usually larger then in where? | The superficial system |
| What is a major risk of a thrombus in the deep system? | A life threatening pulmonary embolism (PE) |
| What make muscular calf veins a challenge to image? | They're very small with accompanying arteries |
| What do Soleal veins dump into? | Posterior tibial veins and peroneal veins |
| Gastrocnemius veins dump into what? | The Popliteal vein |
| Where is the most often site of symptomatic thrombus? | Muscular calf veins |
| If a thrombus is visualized, what must you verify? | Whether the Popliteal vein is involved |
| Where is the Popliteal vein located? | Medial posterior to Popliteal artery (moves lateral as it passes through the adductor canal (lower thigh)) |
| What is the femoral vein a continuation of? | The Popliteal vein after it passes through the adductor canal |
| What does the Femoral artery accompany? | The superficial Femoral artery |
| What courses the thigh along with the Profunda Femoris Artery? | Profunda Femoris Vein |
| What begins at the confluence of the Femoral and Profunda femoris veins? | The Common Femoral Vein |
| The Common Femoral vein lies ______ to the common femoral artery. | Lies Medial to the CFA |
| The common femoral vein continues into the _______ at the ________ above the __________ | continues into the pelvis, at the external iliac vein, above the inguinal ligament |
| Where are Posterior Tibial Veins located? | Begin Medial side of ankle (medial mallelous) |
| Posterior Tibial Veins accompany what? | Posterior Tibial Artery |
| Where do the Peroneal Veins begin? | At the lateral side of the ankle (lateral mallelous) |
| Peroneal veins ascend the calf with the _____ ______ | Peroneal Artery |
| Where do the Posterior Tibial and Peroneal Veins join? | About two-thirds of the way up the calf (Common Trunks) to become the tibioperoneal trunk |
| What are the Anterior Tibial Veins a continuation of? | A continuation of the Dorsalis Pedis |
| Are Anterior tibial veins paired? | yes |
| Anterior Tibial Veins pass between the what? | Tibia and Fibula |
| Anterior Tibial Veins travel up/down the anterior lower leg? | UP anterior lower leg |
| Anterior Tibial Veins join with the tibioperoneal trunk veins to form the? | Popliteal Vein |
| Superficial veins travel close to what? | The skin's surface |
| Superficial veins are what? and do not have what? | Smaller than deeper veins, and do not have an accompanying artery |
| Superficial veins are less likely to cause what? | Life-threatening PE as thrombus is smaller and veins are not surrounded by muscles |
| There is a greater potential for embolus with superficial veins if thrombus is near what? | Junction with deep system |
| What connects superficial veins to deep veins? | Perforators |
| Blood flow is from _____ to ______ | Superficial to deep |
| What is the role of perforators? | To keep blood from spending too much time near the skin surface |
| Perforators have one way valves to keep blood moving toward the _________ | Deep System |
| If perforators are not functioning what can happen? | Blood can pool in distal legs, causing stasis changes and venous ulceration |
| What beings just anterior to the medial mallelous? | Great Saphenous Vein |
| What is the longest vein in the body? | Great Saphenous Vein |
| What vein ascends the leg medially with several tributaries along it's length? | Great Saphenous Vein |
| What are the 3 main perforators? | Cockett's, Boyd's, Dodds's |
| Where is Cockett's perforator found? | The Calf |
| Where is Boyd's perforator found? | The Knee |
| Where is Dodd's perforator found? | The Thigh |
| The Great Saphenous Vein terminates into the Common Femoral vein at the __________ ___________ | Saphenofemoral Junction |
| Where does the small saphenous vein course? | The small saphenous vein courses posteriorly up the calf |
| The Small saphenous vein typically terminates into the ____ ______ at the __________ _________ | Into the Popliteal vein at the saphenopoliteal junction |
| The small saphenous vein may continue above the knee as the vein of _________? | Giacomini |
| Veins carry blood where? | Towards the heart |
| what are the 3 layers of veins? | Tunica intima, tunica media, and tunica adventitia |
| Venous walls are thinner/ thicker than arteries? | Thinner |
| Walls of veins are mainly what? | Connective tissue |
| What are unique to veins? | Valves |
| What do valves prevent? | Prevent retrograde movement of blood |
| What are valves? | Bicuspid inward projections of tunica intima |
| What is a sinus? | An enlarged area behind leaflets |
| Valves are more numerous where? | In lower extremities |
| Valves are absent where? | In veins of the thorax and abdomen |
| Veins are _________ vessels of the body? | Capacitance |
| What is another important role of veins, besides sending blood towards the heart? | Serving as a reservoir (storage of blood) |
| About how much of the total blood volume does the venous system hold? | About two-thirds (60%) |
| Distended veins can be how many times larger in cross-sectional areas than the corresponding artery? | Three to Four times larger |
| What also adds to the ability to hold blood? | Paired veins (found in distal extremities) |
| What is transmural pressure? | The difference between the pressure within the vein and the tissue pressure |
| What does high transmural pressure indicate? | Distended vein |
| What does low transmural pressure indicate? | Collapsed, elliptical vein |
| What changed transmural pressure? | Patient position |
| If the patient is supine the transmural pressure will be high or low? | Low |
| If the patient is stand the transmural pressure will be high or low? | High |
| What plays a large role in venous resistance? | Vein shape |
| What type of veins offer little to no resistance to flow? | Distended, circular veins |
| What type of veins offer a great deal of resistance to flow? | Partially empty elliptical veins |
| What permits veins to accommodate increases in blood flow without causing increases in the pressure gradient to the heart? | The ability for the veins to change shape (compliance) |
| Venous compliance allows for what? | More blood from arteriole system (ex. vasodilation during exercise) results in more blood for venous system to return |
| What are some things that can cause vasoconstriction, reducing blood volume? | Cold exposure, stress, and certain drugs |
| Pressure gradient is what? | From high pressure arterial to low pressure venous- Perfusion across capillaries |
| What is hyrdrostatic pressure caused by? | The weight of a fluid as measured comapred to a reference point |
| What is an example of a reference point in the body for hydrostatic pressure? | The right atrium |
| Gravity forces are more prominent in the arterial or venous system? | Venous |
| When supine hydrostatic pressure is what? | Negligible |
| When standing hydrostatic pressure affects what? | Affects overall venous pressure |
| Venous pressure at the ankle increases with what? | Standing (~100 mmHg) |
| Changes in pressure influence the pressure gradient and therefore what? | Blood flow |
| What is the definition of respiratory influence? | Changes in intrathoracic and intra-abdominal pressure profoundly effect lower venous return to the heart. |
| What happens during inspiration? | The diaphragm descends, pressure decreases in the chest cavity, which causes blood to pool into the pulmonary vascular bed, & increased intra-abdominal pressure |
| What happens to the IVC during inspiration? | The IVC collapses and venous return from the legs is impeded |
| What happens during expiration? | Diaphragm ascends, pressure increases in chest cavity, blood flow is decreased in the thorax, inra-abdominal pressure decreases |
| What to flow during expiration? | Flow increases from legs into abdomen |
| Waveform will _______ with inspiration? | Decrease |
| Waveform will _______ with expiration? | Increase |
| Decreased pressure in the chest cavity = what? | Increased intra-abdominal pressure, and venous return from the leg decreases or ceases |
| Increased pressure in the chest cavity = what? | Decreased intra-abdominal pressure, and venous return from the legs increases |
| Respiratory influence is seen where? | In phasic flow on the lower extremity venous waveform |
| What effect does cardiac influence have on normal lower extremity venous? | Cardiac changes are not evident due to venous compliance |
| What effect does CHF have on lower extremity venous? | With CHF increased pressure on the right side of heart can cause lower extremity veins to show pulsatility-bilateraly |
| How does Valsalva maneuver affect lower extremity venous flow? | Intrathoracic and intra-abdominal pressures both greatly increase, causing lower extremity flow to cease completely |
| What will be seen on the waveform upon the release of the valsalva manuever? | Small augmentation |
| If signal augments with valsalva what does that indicate? | Incompetent valves |
| What does the calf muscle pump assist with? | Assists return of blood to heart against hydrostatic pressure |
| "Venous heart" or veno-motor pump does what? | Increases venous return |
| Upon the contraction of a calf pump what happens? | Forces blood up to the heart |
| Upon relaxation of a calf pump what happens? | Blood is drawn into calf veins/sinuses |
| What do venous valves do? | Closure helps reduce venous pressure, Prevent reflux of blood when competent, Keep blood flow unidirectional, Superficial vein and deep calf veins have the most valves |
| Deep vein thrombosis causes what? | Increased venous pressure and resistance |
| Variations in abdominal pressure with respiration have little effect on what? | Pressure gradient in legs with DVT |
| With a DVT what may happen to normal venous flow from lower extremities? | Normal phasic venous flow may be reduced or absent (possible complete obstruction present) |
| What happens to venous flow from legs as venous pressure in legs exceeds intra-abdominal venous pressure? | Flow becomes continuous (possible proximal obstruction present) |
| What are Primary Varicose Veins? | Varicose veins that develop in the absence of DVT |
| What are primary varicose veins caused by? | Incompetent valves in the common femoral and /or great saphenous veins |
| Valves may be congenitally absent where? | In the common femoral and iliac veins |
| Calf muscle pump propels blood which way? | Upward |
| What kind of flow is noted in superficial veins with valvular incompetence? | retrograde flow is noted in superficial veins with valvular incompetence |
| What effect does primary varicose veins have on venous pressure? | Increased venous pressure, which may result in edema or venous ulcers |
| What are secondary Varicose Veins? | Valvular incompetence as a result of valve damage from DVT |
| Where is valvular incompetence is typically noted where? | In the deep, superficial and perforating veins |
| With secondary varicose veins what is completely disrupted? | Venous flow patterns such as flow from deep to superficial or bidirectional flow in perforators |
| With secondary varicose veins what kind of venous pressure is noted throughout system? | Increased venous pressure, may result in edema or ulcers |
| Pregnancy does NOT cause varicose veins but it may what? | Magnify predisposing factors |
| Enlarged uterus compresses the IVC and iliac veins which results in what? | Increased venous pressure |
| Humoral factors (hormones) circulating during pregnancy causes the veins to become more what? | Complaint, which causes venous distention and decrease velocity in venous flow |
| The enlarged uterus and the humoral factors can lead to what? | the development of varicose veins and DVT |
| How are venous stasis ulcers created? | ↑ venous pressure results in distention of capillaries & ↑capillary pressure, Junctions between endothelial cells open & plasma proteins move into tissue, Extra fluid allows protein movement, As a result tissue damage & ulceration occur |
| What leads to ischemia and ulceration? | Decreased oxygen transfer and nutrients at the capillary level |
| Where do venous ulcers typically occur? | Near the medial mallelous (medial ankle) |
| What are some characteristics of venous ulcers? | Mild to severe pain, Shallow & irregular shape, venous ooze/bleeding, |
| What are some other findings with venous ulcers due to valvular incompetence? | Brawny discoloration (stasis dermatitis), and varicosities |
| What is edema usually a sign of? | Increased venous pressure |
| With edema increased pressure forces fluid between interstitial spaces, which prevents ________ and can lead to _________________ | Prevents re-absorption, and can lead to brawny skin discoloration (stasis dermatitis), varicosties and venous ulcers |
| What is pitting edema? | Fluid can be displaces with manual pressure - "ant farm" appearance on ultrasound |
| What is non-pitting edema? | Tissue is so swollen with fluid that is cannot be displaced with manual pressure |
| What is stasis dermatitis? | Brawny discoloration |
| standing increases capillary pressure which results in what? | Fluid loss, and edema if not absorbed by interstitial tissue |
| Calf pumps empties veins and decreases venous pressure which limits what? | Edema |
| Venous thrombosis increases/decreases venous pressure which results in what? | Increases, results in increased capillary pressure and fluid loss (edema) |
| What can help reduce capillary pressure and limit edema? | Compression stocking and elevating the legs |
| Where is excess fluid normally collected as fluid is moving across the capillary bed? | Excess fluid is normally collected by lymphatics |
Created by:
EmilyGriffin
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