Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Vascular sonography
Lower Extremity Venous Valvular Insufficiency
| Question | Answer |
|---|---|
| How can venous valve leaflets be identified? | On B-mode imaging |
| What are the characteristics of Venous Valves? | Bicuspid valves with leaflets that point in the direction of normal venous drainage, Vary in number, ↑ in frequency with distance away from heart, ↑# in calf veins and superficial system |
| Venous Valves open with _________ _________, and close with _________ __________. | Open with Muscular Contraction, and close with Muscular relaxation |
| Incompetent Valves allow what? | Abnormal retrograde flow |
| Visual signs of venous valve insufficiency includes what? | Spider Veins, Telangiectasias, Reticular Veins, Varicose Veins, Edema (also a palpable sign), Skin Changes, and Ulceration |
| What may cause Edema? | Many patients have temporary swelling at the end of a day of work, after prolonged standing, or as a consequence of certain activities or leg positioning |
| Edema source must be what? | Differentiated; sources include (besides venous obstruction or insufficiency) |
| What are the skin changes associated with Venous Valve insufficiency? | Stasis Dermatitis, Lipodermatosclerosis, and Ulcerated wounds |
| What is Stasis Dermatitis? | Brawny Skin Discoloration |
| What is Lipodermatosclerosis? | Hardening of skin |
| What are other symptoms dealing with venous valve insufficiency? | Heaviness, Tension, Aching & Fatigue, Restless legs, Muscle cramps, Tingling discomfort, Pain, Burning, Itching, Skin irritation, Tightness |
| What is CEAP? | It is the international standard for describing clinical manifestations of chrinic venous disease |
| What doe the letters of CEAP stand for? | C=Clinical disease class E= Etiology A= Anatomic distribution of reflux P= underlying Pathophysiology |
| Clinical Classification C0 means what? | No venous insufficiency signs or symptoms |
| Clinical Classification C1 means what? | Telangiectasias and/or reticular veins (<3mm in diameter) |
| Clinical Classification C2 means what? | Varicose Veins (≥ 3mm in diameter) |
| Clinical Classification C3 means what? | Edema |
| Clinical Classification C4 means what? | Skin changes presently subdivided into: C4a-Minor skin changes C4b-Major skin changes such as lipodermatosclerosis |
| Clinical Classification C5 means what? | Healed skin ulcers |
| Clinical Classifications C6 means what? | Open skin ulcers |
| If acute DVT is identified then what happens? | CVI exam is discontinued; patient is referred for treatment |
| What is seen on normal B-mode? | Smooth, thin-walled, fully compressible veins with no obvious change in venous diameter |
| What is seen on B-mode with Acute DVT? | Enlarged, incompressible vein with hypoechoic material in lumen |
| What is seen on B-mode with Chronic DVT? | Small, retracted vein; partially or completely incompressible with hyperechoic material |
| What are the characteristics with chronic venous valvular insufficiency? | Enlarged vein diameter, Vein remains completely compressible, Lumen is hyperechoic, anechoic, MAy see valve sinus with flapping valve leaflets, and Tortuous veins |
| What do normal veins show with color flow? | Show respiratory phasicity and augmentations with maneuvers |
| What do veins with a DVT show on color flow? | No flow if completely occlusive; flow around thrombus if not occlusive |
| Color may be used to visualize flow in small, tortuous channels or as an indicator of what? | Recanalization, retrograde flow can be visualized but is not quantitative |
| What else is color flow helpful with? | Helps place sample volume in area of most reflux, and Is helpful but Spectral Doppler should be used to determine flow direction and flux times |
| What is seen on Normal Spectral Doppler? | Spontaneous, phasic with respiration, unidirectional flow toward heart, Flow augments with distal compression or release of PROXIMAL compression |
| What is seen on Spectral Doppler with an acute DVT? | No flow- if fully occlusive, Lack of augmentation with distal compression or release of PROX compression. Partial obstruction or external compression can cause continuous flow |
| What is seen on Spectral Doppler with chronic DVT? | Small, tortuous channels with in disease vein segment, Flow in collateral veins |
| What is shown with Chronic Venous Insufficiency (CVI)? | Reversed flow noted following PROX compression or release of distal compression |
| Compression maneuvers are used to elicit what? | Reflux |
| What is the NORMAL response to PROXIMAL compressions? | Flow should increase during compression (in an antegrade direction) and stop upon release of compression |
| What is the NORMAL response to DISTAL compressions? | Flow should increases during compression (antegrade direction)and stop upon the release of compression |
| What is the ABNORMAL response to PROXIMAL compressions? | Retrograde flow occurs during compression, Antegrade flow resumes upon release of compression |
| What is the ABNORMAL response to DISTAL compressions? | ↑ in antegrade flow during compression, Retrograde flow is noted upon release of compression |
| Reflux duration (time measurement) should be performed with Spectral Doppler with vein where? | In long |
| What is the NORMAL closure time for saphenous veins (superficial)? | < 500 msec (or 0.5 sec) |
| What is the NORMAL closure time for femoropopliteal veins (deep)? | < 1 sec |
| longer closure times are associated with what? | Abnormal reflux |
| What are the pitfalls associated with venous valve insufficiency? | Equipment must be set properly to detect venous flow |
| Technical factors include: | Gain (alters sensitivity of Spectral Doppler or Color Flow) , Velocity Scales (PRF) affects Doppler sensitivity, Different instruments have different settings that may affect detection |
| What is a common finding for Chronic Venous Insufficiency (CVI)? | Lower venous flow |
| Varicose veins have a prevalence up to ____ in women and _____ in men? | 60% in women and 56% in men |
| What is CVI often associated with? | Telangiectasias, edema, skin changes, and ulcers |
| Reflux of the lower extemities is present in up to _____ of general populations. | 35% |
| Prevalence of reflux does what with age? | Increases |
| What vein shows the highest prevalence of reflux? | Great Saphenous Vein |
| What is the treatment for superficial venous disease? | Stripping & Ligation, Endovenous Thermal Ablation, Chemical Ablation/SClerotherapy, Phlebectomy (microincision) |
| What is the treatment for deep venous disease? | Anticoagulation, Valve replacement, Venoplasty/Stenting, Thrombolysis, Chemical/Physical recanalization |
| What treatment option has become a popular choice for most individuals? | Endovenous Ablation |
| How is Endovenous Ablation performed? | With either Radiofrequency (RFA) or Laser Energy (ELA), Vein is closed from within, Done with ultrasound guidance |
| Stripping & Ligation was a traditional treatment what is it associated with? | "Neovascularization"; reappearance of Varicose Veins |
| What may Microphlebectomy be used with? | Larger Veins that are close to the skin surface |
| What works well for smaller varicosities? | Sclerotherapy |
| What happens with Endovenous Thermal Ablation? | Vein is accessed under ultrasound guidance, guide wires & sheaths are placed using ultrasound |
| Thermal device tip is positioned where? | In Saphenous Vein distal to confluence with deep venous system |
| Where is Anesthesia place? | In Saphenous Sheath, then heating of thermal device is activate and then the device is pulled back through the insertion site |
| What happens after the Ablation? | Immediately, vein is still compressed by tumescene, Due to thermal injury inside vein, vein gradually shrinks, Prior to disapperance, treated vein will appear "thrombosed" |
| After the Ablation what occurs over 6 to 9 months? | Segmentally, sonographically absent, Fibrosis or Thrombosis visualized, and Recanalization may occur |
| What will happen to the treated vein after 6 to 9 months? | The treated vein will disappear |
Created by:
EmilyGriffin
Popular Sonography sets