vascular unit 4 - the venous duplex

normal competency

no flow immediately after augment flow or at beginning of proximal compression

determining presence of DVT or SVT

The vein is free of echogenic material, the vein fully collapses while applying transducer pressure on the skin, the vein is patent and demonstrates normal venous spectral doppler signal

lower extremity phasic flow

increase with expiration, decrease with inspiration

upper extremity phasic flow

decrease with expiration, increase with inspiration

abnormal spontaneity

no flow without compression maneuver

abnormal phasicity

no continuous flow present

abnormal pulsatility

present in lower extremity

abnormal augmentation

decreased augmentation, don’t want flow above the baseline

abnormal competency

retrograde flow present after distal compression or on proximal compression (now termed incompetent

pulsatile flow

can be normal in upper extremity, abnormal in lower extremity

pulsatile flow in lower extremity

indicated fluid overload, CHF, rapid IV infusion, venous insufficiency or distal obstruction

continuous flow

abnormal in both lower and upper extremities, indicates proximal obstruction

deep vein thrombosis

characterized by the abnormal coagulation of RBCs, thrombi can be isolated to a single vein or extensive, may be acute or chronic

venous thromboembolism (VTE)

condition in which a venous thrombus dislodges from the vein wall, and propagates to the arteries of the lungs, and causes a PE

acute deep vein thrombosis

less than a week old, characterized by a soft or spongy appearance and may or may not envelope the entire cross-section of the vein, possible symptoms, severe symptoms: phlegmasia alba dolens, phlegmasia cerula dolens

may-thurner syndrome

left common iliac compression (and potentially thrombosis) by the right common iliac artery

Phlegmasia alba dolens

swollen, painful, white leg (blanching), AKA: milk leg or white leg

phlegmasia cerulea dolens

swollen, painful, cyanotic leg, venous outflow is completely obstructed, may result in arterial insufficiency and venous gangrene

acute deep venous thrombosis treatments

conservative - consist of elevation, compression stockings, and/or bed rest

common anticoagulants

heparin, warfarin (coumadin) lovenox

thrombolytic therapy

used to dissolve or break down an existing thrombus, know as thrombolysis

chronic deep venous thrombosis

> than a week, more dense and often calcified, more echogenic, cause diffuse wall thickening, typically adhered firmly to the vessel wall, low risk for causing a PE, obstructive and can cause formation of collateral vessels and varicose veins

entire extremity symptoms (CDVT)

edema - swelling, hyperpigmentation, limb heaviness, varicose veins, venous ulcerations

post-thrombotic syndrome

from CDVT, caused by ambulatory venous pressure, AKA venous hypertension, venous blood is unable to overcome hydrostatic pressure, resulting in the blood getting stuck in the legs, leads to an ulceration if left untreated

primary varicose veins

congenital, stemming from an inherent weakness of the venous walls, and occur without coexisting deep venous tissue

secondary varicose veins

occur secondary to pathology (CDVT) of the deep venous system

superficial venous thrombosis

clot formation, common location is on or around the valves, chronic can cause incompetence, leading to insufficiency of the superficial venous system

venous insufficiency (venous reflux)

caused by incompetent venous valves, competent valves aid venous blood in overcoming hydrostatic pressure, leads to venous stasis and venous hypertension in the lower limbs

venous reflux testing

identify the presence and location of incompetent venous valves, symptoms: swelling, induration, and sometimes ulcers

vein mapping

determines the vein’s stability for use as bypass conduit and to identify its anatomic route, performed before lower extremity bypass or coronary bypass operations, AV fistula for dialysis

Baker’s cyst

fluid collection that can be found in popliteal fossa, communicating bursa, excess fluid can be related to any type of arthritis, uni or bilat, can mimic DTV symptoms