Alternative Diagnostic Testing & Medical Therapies

venous disease diagnostic test types

dx tests for possible dvt/reflux and eval for pulmonary embolism

possible dvt/reflux tests

d-dimer and contrast venography

eval for pulmonary embolism tests

lung ventilation/perfusion scan, pulmonary angiography, CTA of chest

d-dimer

protein fragment produced when a blood clot dissolves in the body, product breakdown is directly related to d-dimer value

d-dimer test lack ______and ______

specificity, positive predictive value

elevates d-dimer labs

pregnancy, liver disease, renal disease, cancer, or any thrombotic process including recent surgery

contrast venography

gold standard but use has decreased due to accuracy of US

ascending contrast venography

images veins dist-prox and detects venous abnormalities includidng DVT

descending contrast venography

images veins prox-dist and assesses valve function and reflux

ascending contrast venography requires ______ to be injected into the _____ and directed to deep system

contrast, dist superficial vein

contrast in lower extremity contrast venography

vein on dorsum of foot

contrast in upper extremity contrast venography

basilic or cephalic veins

contrast in descending contrast venography

only in lower extremity, in CFV

evidence of obstruction in ascending contrast venography

any deviation from normal such as filling defect indicating the displacement of contrast material by thrombus

evidence of reflux in CFV/FV in descending contrast venography

retrograde filling

lung ventilation/perfusion scan AKA

V/Q Scan AKA

V/Q Scan

a ventilation/quotient scan measures air and blood flow in the lungs and is a screening test for the detection of perfusion defects in the lungs

pulmonary angiography

specifically used to eval the pulmonary arteries for pulmonary embolism

CTA

a computed tomography angiography has become the study of choice to eval pulmonary embolism

virchow’s triad

3 causes of venous thrombosis: venous stasis, trauma, and hypercoagulabiltiy

venous stasis risk factor prevention

limit long periods of inactivity or bed rest and promote drainage when pt is inactive

ways to promote drainage

leg elevation, support stockings, pneumatic compression devices, weight management

trauma risk factor prevention

prevent infection or injury of the extremity

hypercoagulability risk factor prevention

awareness of hypercoagulability states/factors

medications used to decrease the risk of dvt in high risk population

unfractioned heparin, low-molecular weight heparin (lovenox/arixtra)

anticoagulation for acute dvt and pe

heparin and warfarin

heparin requires ______ until oral anticoagulation is deemed therapeutic after ______

continous infusion, 4-5 days

warfarin aka _____ dosage is regulated until patient’s PT is ______

coumadin, 1.5-2 x normal

varicose veins

result of chronic ambulatory venous hypertension or high pressure in the veins due to loss of functionor obstruction

associated with varicose veins

pregnancy, heredity, prolonged standing, trauma, age, and obesity

ablation

destruction of a body part’s function

microphlebectomy

myay be considered wen veins are too superficial for ablation

GSV incompetence

most common cause of varicose veins

____ ablation, as well as some perforating veins, effectively treats _____

SSV, reflux

2 types of ablation

radiofrequency and endovenous laser ablation

in ablation, approx every _____ along the course of the vein, _____ is administered

5 cm, anesthetic fluid

anesthetic fluid

accurate placement protects surrounding tissue from thermal effects of intravascular energy by serving as a heat sink

sclerotheraphy

used to treat small varicosities, a tiny needle of sclerosing solution in the damaged vein will collapse and fade it

IVC filter

An IVC interuption device helps prevent pe and is useful for patients who cant use anticoagulants

iliofemoral venous thrombectomy

may be performed in pt with impending limb loss if thrombolytic therapy does not dissolve clot

TIPPS

transjugular intrahepatic portosystemic shunt is a percutaneous procedure to create a shunt between PV/Hep V

sono role before ablation

confirm reflux, caliper, and depth of vein

sono role during ablation

access site, placememnt of cath/laser fiber, anesthetic solution placement

sono role post ablation

confirm vein ablation and absence of thrombosis