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Adv. Vas. Son.
Test 1 Venous Duplex imaging Lower Extremities
| Question | Answer |
|---|---|
| DVT annual estimates: | 1-10 million cases of DVT. 650,000 cases of PE. 200,000-300,000 deaths from PE. 3rd most common cause of death in hospitalized PTs. |
| What are the components of Virchow's triad? | Hypercoagulability, Venous Stasis, Vessel wall injury |
| What are the DVT risk factors? | Post-op state, HX DVT, CX/Malignancy, Thrombophilia, Trauma, Pregnancy, High-does estrogen, Bed rest>4 days, "Economy class syndrome" |
| What is "Economy Class Syndrome"? | Being on a plane for too long in a small cramped area without getting the blood flowing |
| What are ACUTE DVT symptoms? | Persistent leg pain w/ acute onset, Persistent leg swelling, and Calf pain/tenderness |
| If PTs have the ACUTE DVT symptoms, what is the % chance that they will have a DVT? | 50% |
| What is Phlegmasia Cerulea Dolens? | Massive thigh & calf swelling, Limb Cyanosis (blue leg), and Ilio-femoral thrombosis |
| What are the symptoms for Superficial Thrombophlebitis? | Local erythmia/inflammation, Local tenderness, Palpable subcutaneous cord |
| What is usually more painful than DVT? | Superficial Thrombophlebitis |
| Is Superficial Thrombophlebitis life threatening? | Not usually, unless the clot extends/propagates into the deep system |
| What are the Venous presentation on physical exam? | Swelling, limb discoloration, stasis dermatitis/ulceration, and varicose veins |
| Should you do venous or arterial first if they are both ordered? | ALWAYS do VENOUS first |
| What are the acute venous pathology symptoms? | Acute onset SX, Persistent pain in calf/thigh, Limb swelling, Limb Cyanosis (blue), Limb Warmth, and Local tenderness |
| What are the Arterial pathology symptoms? | Progressive, chronic SX, Intermittent pain when walking, No swelling, Limb Pallor (white), Limb coolness, Rest pain, Gangrene, Tissue Necrosis (death) |
| What is the TD for lower extremity exams? | 5-10 MHZ |
| The FV and PFV bifurcation is actually what? | The confluence of the 2 veins |
| What is more important than color for Prox veins? | Spectral Doppler |
| What flow characteristics are assessed with Spectral Doppler? | Spontaneous flow, Phasic w/ respiration, Augments w/ distal limb compression, and Reflux |
| What is Spontaneity? | Flow that is present without augmentation manuevers |
| What is Respiratory Phasicity? | Flow should increase and decrease w/ respiration |
| Where is augmentation optional? | In the thigh and popliteal and much less than the presence or absence of respiratory phasicity |
| What is augmentation useful for? | Calf vein flow wvaluation and for reflux assessment |
| What does continuous venous flow w/out respiratory phasicity mean? | It is ABNORMAL and suggests PROX disease |
| What warrants a scan of the iliac veins in the pelvis? | Steady, continuous, nonphasic flow in the CFV. Can occur w/ isolated iliac vein thrombosis (v. uncommon), or w/ Extrinsic compression of the iliac veins by a mass (common) |
| Respiratory phasicity may not be present due to:? | Shallow breathers (PT w/PE), Supine PTs, PTs who have their arms raised and hands behind their heads, Spinal cord injured PTs due to reduced abdominal muscle tone, and Prox DVT or extrinsic venous compression |
| What is one potential pitfall of LE exam and give examples? | Some normal veins may not compress: CFV when PTs reflux ↑s venous intraluminal pressure (valsalva), POP vein if TD is pressed against the tendons in the posterior knee region, and Calf veins if TD is pressing on Tibia |
| What is a potential fossa pitfall? | Tendons behind knee can prevent compressions |
| Name another pitfall: | Thrombosed Pop vein w/patent high- confluence of ATV |
| If veins do not compress be certain what? | The TD is not pressing against tibia |
| What are some calf vein caveats? | Flow in calf veins is usually not spontaneous, you must often augment flow by squeezing calf or ankle. If PT is symptomatic(tenderness) look for muscular vein thrombosis. |
| If you find a SSV or gastroc vein thrombosis what should you look for? | Extension into POP |
| Will a calf vein clot kill the PT? | No BUT DO NOT MISS CLOT IN POP OR ABOVE |
| If PTV or Pero vein thrombus is detected where must you look? | In distal Pop vein for propagation |
| What is the criteria for patency? All Veins: | Complete coapt of vein walls w/ TD pressure. No visible intraluminal clot. Normal venous doppler signals of spontaneity& phasicity (except. Spon flow may not be seen in calf Vs). See blood throughout lumen with color |
| What is the criteria for venous thrombosis? | See a thrombus. No vein coapt. Vein distension. Abnormal doppler signals. Reduces/absent augmentation. Reduced/absent color fill in |
| Acute DVT signs: | Vein may be distended. Some what hypoechoic. No collaterals. Maybe free floating, don't scrunch it &send it flying |
| Flow PROX to thrombus may have what? | Respiratory changes |
| Flow DISTAL to thrombus is? | Abnormal (non-phasic) |
| What does nonspontaneous flow mean? | Possible distal obstruction |
| Chronic DVT signs: | Echogenic thrombuc. Vein smaller than artery. Collaterals. Recannalization. Residual fibrous bands |
| In the presence of a thrombosed deep vein, collateral veins can become what? | Large and carry a lot of outflow |
| Subacute Vs Acute DVT: | No Thrombus= No Prob. Yes Thrombus= Difficult judgment call. |
| D-dimer test facts | Positive can indicate thrombus formation. Negative means more diagnostic tests as acute thrombosis is not occurring |
| When is the Thrombus life threatening? | If it is found anywhere from Pop to Iliac vein |
| Calf vein DVT may cause PE, BUT what? | Thrombus is too small to be fatal. Same for GSV |
| What are other diagnosis besides DVT? | Pop cyst. Pop A aneurysm. Muscle tear. Hematoma. Lymphedema. Cellulitis |
| What is a Bakers cyst? | AKA Pop cyst. Synovial lining & fluid goes into Pop space. May dissect into medical calf muscle, & may become hemorrhagic |
| Bakers cyst may be what? | Either purely cystic or contain debris & thrombus |
| Where do Bakers cyst originate? | In the joint space. Identify this to differentiate from hematoma |
| synovial lining has a blood supply what does this mean? | This can rupture and blood can flow into Bakers cyst |
| What is a calf hematoma? | Lies within the muscle fibers usually do not extend up into the pop joint space |
| What does Lymphedema look like? | ANT FARM |
| What is MAy-Thurner Syndrome? | Right Iliac Artery compresses Left Iliac Vein, results in DVT of left leg |
| Tumors often have what? | increased arterial flow noted with color |
| Abscess you should look for? | Swirling debris within |
| Arterio-venous fistulas have what? | High venous flow and ow arterial resistance (high velocity, low resistance flow) |
| Symptoms of venous insufficiency: | Recent calf/ankle/foot swelling, Varicosities, Venous claudication, Stasis dermatitis, Ulceration |
| What is Venous Claudication? | A complaint of heaviness in the legs when walking. Arterial inflow is dramatically ↑ed during exercise, but outflow is impeded by chronic outflow obstruction by the inability of calf veno-motor pump to move blood up & out of leg |
| Venous protocol #1: R/O DVT: | look for superficial thrombophlebitis if symptomatic. Perform this for PTs w/ acute SX (SX w/in 2 wks). Don't eval for insufficiency or valvular incompetence these are chronic SX |
| Venous protocol #2: Eval for insufficiency: | For PTs w/nonacute SX of insufficiency. R/O DVT& COO (quickly) by scanning CFV& Pop Vs only, use compression and color. Eval CFV, Prox Fem& Pop v. for reflux. Eval GSV for reflux&SSV if big. Note incompetent Perf Vs & where they connect |
| What is COO? | Chronic outflow obstruction |
| Venous protocol #3: Pre-ablation: | Do protocol #2& add: Eval GSV for reflux ¬e highest level of incomptence, Map course of GSV w/marker. "mark" incompetent Perf Vs. Measure ¬e GSV@ widest diameter. Measure depth of GSV@ shallowest spot. Note the source vein of large varicosities |
| Venous protocol #4: Vein mapping for Arterial Bypass: | R/O Fem V thrombosis. Determine suitability of GSV:Cont. to ankle? Residual clot? Bifid? Abnormal narrowing or aneurysms? Measure dia in Prox,mid,&distal calf. R/O Fem VT |
| When ruling out Fem VT removing the Saph vein is a what? | Contraindication if it's collateral channel in the presence of chronic Fem-Pop DVT |
Created by:
EmilyGriffin
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