Ch. 17 Lower ext venous system; Ch. 18 Upper Ext venous system

A thrombus in the deep venous system is more likely than the superficial veins to be what life-threatening condition?

pulmonary embolism (PE)

What is a major function of the superficial veins?

regulating body temperature

What is the role of perforator veins?

Uses its one-way valves to keep blood moving toward the deep system (connects superficial to deep veins), avoiding stasis changes and venous ulcerations in distal legs

What is Virchow’s triad?

represents the primary mechanism for formation of venous thrombosis

1. venous stasis

2. vessel wall injury

3. hypercoagulable state

What are the clinical markers that can aid in DVT diagnosis?

Well’s criteria, elevated D-dimer (high sensitivity but low specificity)

What vessels can also be bifid?

femoral vein (most common), popliteal vein

What is the major storage area for blood in the calf?

soleal sinus veins in the PTV and peroneal veins

What is May-Thurner syndrome?

Left common iliac vein is compressed (and potentially thromboses) by the right common iliac artery

What is phlegmasia alba dolens? (aka milk leg, white leg)

Extensive iliofemoral DVT that causes marked swelling of lower extremity with pain, pitting edema, and blanching

What is phlegmasia cerulean dolens and its significance?

Extension of phlegmasia alba dolens—complete obstruction of venous outflow with more swelling, pain, cyanosis of the limb; may result in arterial insufficiency and venous gangrene

What is the primary treatment for DVT?

anticoagulation

(other: gradient elastic stockings, thrombolytic agents, thrombectomies)

Upper extremity thrombosis is commonly due to __ while lower extremity is most commonly due to __.

injury to vessel wall; stasis

What is venous thrombosis associated with compression of subclavian vein at the thoracic outlet?

Paget-Schroetter syndrome (aka effort thrombosis)

An optimal position for a bed or an examination table when performing a venous ultrasound on the lower extremity should be:

• straight but slightly tilted with the head elevated.

• straight and flat.

• straight but slightly tilted with the head down.

• positioned with the head elevated and the lower extremity flat.

straight but slightly tilted with the head elevated

Which statement about D-dimer testing is correct?

It will be elevated only in patients with a DVT or superficial thrombophlebitis.

It measures the clotting time of the blood.

It will be elevated in the presence of a deep venous thrombosis (DVT).

False negatives do not occur.

It will be elevated in the presence of a deep venous thrombosis

There are several incidental findings that can be observed during a lower extremity venous ultrasound. Which of the following is not a typical incidental finding?

A tumor

An enlarged lymph node

An aortoenteric fistula

A hematoma

An aortoenteric fistula

The most accurate method to determine that a vein at any given point is thrombus free is to:

directly visualize an anechoic venous lumen.

display color completely filling a vein.

obtain phasic and augmentable venous Doppler signals from the vein.

completely compress the vein walls together.

completely compress the vein walls together.

Which of the following could lead to a false-positive finding on a venous ultrasound examination?

If the patient is placed in Trendelenburg position

If the patient bears down due to discomfort, this may make the vein difficult to compress

If the color pulse repetition frequency is too low

If the B-mode gain is too low

If the patient bears down due to discomfort, this may make the vein difficult to compress

What is the cause of chronically thrombosed veins appearing contracted?

Sympathetic nerves are activated, causing vasoconstriction.

Collateral veins develop, which reduces pressure in the venous system.

The body begins to normalize venous pressures, which decreases vein size.

As the thrombus ages, the plasma gets reabsorbed, which results in the thrombus contracting.

As the thrombus ages, the plasma gets reabsorbed, which results in the thrombus contracting.

When selecting a transducer to insonate the common femoral vein, which frequency will be the most appropriate to start with?

A 12 MHz

A 10 MHz

A 5 MHz

A 3.5 MHz

A 5 MHz

While examining a patient supine on an examination table with a slight tilt, you find it difficult to visualize the calf veins. What is an effective step to take to better visualize the veins?

Put the patient into a Trendelenburg position.

Have the patient sit at the side of the bed and dangle their legs.

Have the patient drink 16 to 32 ounces of water.

Turn up the air conditioning in the room to make the patient more comfortable and relax.

Have the patient sit at the side of the bed and dangle their legs.

All of the following are associated with phlegmasia cerulea dolens except:

massive swelling.

arterial ischemia.

blanching.

cyanosis.

blanching

All of the following are common symptoms associated with deep venous thrombosis except:

chest pain.

lower extremity discoloration.

lower extremity swelling.

calf tenderness and pain.

chest pain.

A major storage area for blood in the lower extremity is:

the great saphenous veins and their tributaries.

the perforating veins.

the gastrocnemius veins.

the soleal sinus veins.

the soleal sinus veins.

Two drugs commonly used to treat patients with a deep venous thrombosis include:

aspirin and heparin.

warfarin and heparin.

aspirin and warfarin.

aspirin and clopidogrel.

warfarin and heparin.

The soleal veins empty into:

the small saphenous veins.

the gastrocnemius veins.

the popliteal vein.

the posterior tibial and peroneal veins.

the posterior tibial and peroneal veins.

A pulsatile lower extremity venous Doppler signal can be expected with all of the following conditions except:

congestive heart failure.

a traumatic arteriovenous fistula.

pulmonary hypertension.

an iliac vein thrombosis.

an iliac vein thrombosis.

Normal lower extremity venous Doppler signals respond to normal breathing patterns by:

ceasing during expiration.

increasing during inspiration.

becoming continuous, monophasic signals during expiration.

ceasing during inspiration.

ceasing during inspiration.

Rapid treatment of iliofemoral thrombus can include all of the following except:

catheter-based thrombectomy.

use of low-molecular-weight heparin.

surgical thrombectomy.

thrombolytic agents.

use of low-molecular-weight heparin.

The three components of Virchow's triad are:

lack of competent valves, venous stasis, and inefficient calf muscle pump.

lack of competent valves, prolonged standing, and family history.

venous stasis, vessel wall injury, and hypercoagulability.

venous stasis, prior thrombus, and hypercoagulability.

venous stasis, vessel wall injury, and hypercoagulability.

What do perforating veins do?

Help gather blood from the calf muscles

Provide for connections between the various superficial veins of the lower extremity

Connect the deep veins with the superficial veins, moving blood from the superficial to the deep system

Regulate body temperature

Connect the deep veins with the superficial veins, moving blood from the superficial to the deep system

Imaging of the iliac vein should be performed for which of the following?

When common femoral Doppler signals are pulsatile

When common femoral Doppler signals are continuous

In every patient presenting for a lower extremity venous ultrasound

When there is asymmetrical calf swelling

When common femoral Doppler signals are continuous

What technique can be employed to improve adequate compression of the femoral vein as it passes through the adductor canal?

The compressions should be performed with a curved linear array transducer.

Pressure should be applied along the posterior aspect of the leg.

The patient should be asked to Valsalva.

The patient should be placed in a reverse Trendelenburg position.

Pressure should be applied along the posterior aspect of the leg.