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Adv. Vas. Son.

Test 1 Venous imaging of upper extremities

QuestionAnswer
What is the 1st difference between lower and upper extremity scans? Thrombi in LE often caused by stasis; not so in UE (no soleal sinuses)
What is the 2nd difference between lower and upper extremity scans? Superficial veins affected more in arms than in legs, also superficial thrombosis may have greater clinical significance in arm
What is the 3rd difference between lower and upper extremity scans? Venous anatomy of upper extremity is more variable than lower extremity
What are venous symptoms? Pain & swelling in arm/neck (may be unilateral), SOB, CP, PE, local erythema, palpable cord, dilated super veins of arm/shoulder, facial swell or dilated chest vessel collatorals, catheter infusion, pre-op ass. for hemodialysis access placement
What is Virchow's triad? Hypercoagulabiltiy, venous stasis, vessel wall injury
Intimal injury is a common reason for upper DVT, what can cause intimal injuries? Indwelling venous catheter, pacer wire, and stents
How can stasis cause DVT? Thoracic outlet compression, or effect induced compression, or compression by mass
What are other reasons for DVT? Radiation induced fibrosis, venipuncture, and IV drug abuse
What 2 TDs are recommended for Upper extremity scans? Mid range (5-10 MHz) linear array- used for IJV, Brachiocephalic, Subclavian, Axillary, Basillic, and Brachial High Freq (10-18 MHz)- used for more superficial veins (cephalic) & small forearm veins (radial & ulnar)
Can a curved or sector array be useful in Upper extremity scans? Yes can be useful for deeper vessels near clavicle and sternum
What are the DEEP veins? Radial/Ulnar(usually 2), Brachial (sometimes 2), Axillary, Subclavian, Internal jugular, Innominate(brachiocephalic), and SVC
What are the SUPERFICIAL veins? Cephalic, Basilic, Median cubital(connection between the cephalic and basilic)
What are the CENTRAL veins? External jugular, Anterior jugular, Jugular arch vein, Inferior thyroid, and Internal mammary
What is commonly seen in the jugular vein? Reverberation artficat and Rouleax (slow flow)
What is it important that a comparison be made with the contralateral subclavian vein? Because the subclavian waveform assessment is cirtical and required by the IAC
When scanning the subclavian what happens to the vessel if you get the PT to take a quick breath in through pursed lips- like sucking through a straw? The subclavian will collapse
How should the flow be in the distal subclavian and Prox axillary veins? Phasic and pulsatile
What are facts about the forearm veins? Radial/Ulnar(deep) & Cephalic/Brachial(superficial) Often only done if PT is symptomatic, Pre-op assessment for hemodialysis access placement(scan only super), Pre-op for vein harvest for arterial bypass (determine patency and size)
What side is the Radial on? Thumb side
What side is the Ulnar on? Pinky side
What are NORMAL upper extremity veins interpretation? Veins central to ax veins have pulsatility, phasicity, & central flow direction. Complete color fill in. No clot seen, walls smooth w/anechoic lumen. Vein diameter will change slightly w/resp. Sub vein flows are symm w/other vein. Vs ↓ axilla compress
What are ABNORMAL upper extremity veins interpretation? See a clot. Presense of echogenic material. Absence of spontaneous flow or pulsatility in Prox Vs. Lack of coapt of any V ↓ axilla, Abscene of color flow
What is an important ABNORMAL interpretation of upper extremity veins? Persistent retrograde flow in IJV or EJV suggest obstruction in innominate vein.
Describe an ACUTE thrombus. Poorly attached, Dilated vessel, and Spongy texture
Describe a CHRONIC thrombus. Brightly echogenic, well attached, and contracted vessel
What is the criteria for venous thrombosis in upper extremities? summary Visualization of thrombus, Lack of vein collapse, No flow: color and spectral, and Abnormal flow patterns and flow direction in central veins
What are the treatments for clots? Anticoagulation, Catherter removal, Thrombolytic therapy, Surgical intervention, and Conservative treatment
Where are Venous Catheters usually encountered? Indwelling venous catheters are commonly encountered in the arm
What do catheters appear as? Appear as bright, straight, parallel echoes within the vessel lumen.
What may develop around the catheters? A thrombus, appears as echogenic material around the catheter surface, Spectral Doppler signals will be diminished &/or continuous
What must happen to the Catheter is it becomes thrombosed? It must be removed
What does PICC mean? Peripherally inserted central catheter- must also be evaluated for thrombus
Upper Extremity venous thrombosis occurs in _____ of PTs with indwelling catheters? 15-30%
What is Paget-Schroetter syndrome? Spontanous thrombosis of subclavian-axillary vein
What is also known as "Effort Induced" thrombosis? Paget-Schroetter syndrome, it is repeated extrinsic compression of the sunclavian and axillary veins and can lead to thrombosis of these vessels
Who are the typical patients of Paget-Schroetter syndrome? Young, athletic, muscular males
What is Superior Vena Cava syndrome? Occlusion or compression of SVC, Venous inflow may be compromised w/ thrombosis or extrinsic compression in the SVC. -Identify abnormal venous flow bilaterally, ↑ed venous pressure, Edema of neck, face & arms, usually bilateral due to venous congestion
Created by: EmilyGriffin
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