Duplex Imaging of the Lower Extremity Venous System Flashcards

Flashcards for Duplex Imaging of the Lower Extremity Venous System

Duplex Ultrasound

The method of choice for imaging DVT.

Deep Veins

Main conduit for blood returning to the heart, accompanying an artery of the same name.

Superficial Veins

Travel close to skin surface in subcutaneous tissue, playing a large role in regulating body temperature.

Pulmonary Embolism (PE)

A blockage of an artery in the lungs by a substance (blood clot) that has moved from elsewhere in the body through the bloodstream.

Reversed Trendelenburg Position

Tilting the bed to allow veins to fill with blood, making them easier to visualize.

Common Femoral Vein (CFV)

Visualized side by side with the common femoral artery (CFA) in a transverse view at the level of the groin.

Great Saphenous Vein (GSV)

Terminates into the CFV just below the level of the inguinal ligament.

Femoral Vein (FV)

Located in the upper thigh alongside the deep femoral vein (DFV).

Popliteal Vein

Located alongside the popliteal artery.

Gastrocnemius Veins

Located in the upper calf, with the small saphenous vein (SSV) superficial to them.

Posterior Tibial Veins (PTV) and Peroneal Veins (Pero V)

Located in the medial calf.

Soleal Sinus Veins

Major storage for blood in the calf, a common site of thrombus formation.

Iliac Veins

Doppler signal at CFV provides indirect assessment; phasic flow suggests lack of obstruction, continuous flow suggests IVC or iliac obstruction.

Virchow's Triad

Risk factors for DVT: Changes or injury to vein walls, venous stasis, and hypercoaguability of blood.

Venous Stasis

Allows for increased exposure to clotting factors.

Hypercoagulability

Associated with diseases (cancer) or medications (birth control pills).

Venous Thrombi

Commonly begin around valve cusps in the calf due to slower blood flow.

D-dimer

Clinical marker that can aid in diagnosis for PE.

Perforators

Connect superficial veins to deep veins, keeping blood from spending too much time near the skin surface.

Venous Valves

Maintain unidirectional flow (superficial to deep) and offsets the effects of hydrostatic pressure.

Well's Criteria

Clinical markers that can aid in the diagnosis of PE.

Thrombus-free Veins

Will compress completely with transducer compressions.

Doppler Signals (Normal)

Should display spontaneous Doppler signals, respiratory phasicity, and augmentation with distal compression.

Echogenic Material in Vein

Prevents complete compression of vein walls, indicating presence of thrombus.

Acute DVT

May be sonolucent, spongy, loosely attached, and cause dilated vessel lumen.

Chronic Thrombus

More echogenic thrombus, well attached, irregular vein walls, and smaller vessel size.

Thrombosed Vein

Absence of color flow and spectral waveforms.

Pulsatile Flow in Veins

Associated with arteriovenous fistulae and systemic venous hypertension.

Edema

Sequela of DVT, skin changes.

Brawny Discoloration

Sequela of DVT, skin changes in gaiter zone.

Venous Insufficiency (Primary)

Hereditary, not related to DVT.

Venous Insufficiency (Secondary)

Associated with repeated episodes of DVT, pregnancy, or obesity.

May-Thurner Syndrome

Left common iliac vein compression by the right common iliac artery.

Phlegmasia Alba Dolens

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

Phlegmasia Cerulea Dolens

Extension of phlegmasia alba dolens, causing massive swelling, severe pain, and cyanosis of the limb.

Venous Ulcers

Near medial malleolus, pain is mild, irregular in shape, and shallow.

Baker's Cyst

Nonvascular incidental finding.

Aneurysms

Vascular incidental finding.

Contrast Venography

Imaging procedure that's uncommon for venous studies.

Heparin

Treatment for DVT - anticoagulation.

Warfarin

Treatment for DVT - anticoagulation.

Gradient Elastic Stockings

Compression stockings used as treatment for DVT.

Venal Caval Interruption Device

Greenfield filter used in treatment of DVT.

Deep Veins

Located beneath the muscular fascia, higher risk for embolism due to squeezing action of surrounding muscles.

Superficial Veins

Less likely to cause life-threatening PE as thrombus is smaller and veins are not surrounded by muscles.

Vein of Giacomini

Cranial extension of small saphenous vein that can terminate directly into the femoral vein, inferior gluteal vein, or communicate with the GSV.

Hydrostatic Pressure

Offsets effect of unidirectional flow.

Venous Stasis Risk Factors

Bed rest, immobility, Myocardial infarction.

Hypercoagulability Risk Factors

Pregnancy, cancer, estrogen intake, myeloproliferative disorders.

Changes/Injury to Vein Walls Risk Factors

Trauma, surgery, iatrogenic injury.

Gaitor Zone

Discoloration associated with chronic DVT.

Bed Positioning for LEA Study

Bed should be tilted in reversed Trendelenburg position to allow veins to fill with blood.

External iliac

Has valves in 25% of the population.

Spontaneous Doppler signals

Normal Doppler Signal.

Respiratory phasicity

Normal Doppler Signal.

Augmentation with distal compression

Normal Doppler Signal.

Cessation of flow with proximal compression or Valsalva maneuver

Normal Doppler Signal.

Valve leaflets

May be seen as thin white structures within sinus

Tail of the Dog

Loosely attached Acute DVT

Arterial Ulcers

Tibial area, toes, & bony prominences.

Arteriovenous fistulas

Vascular incidental finding.

Significant arterial disease

Vascular incidental finding.

Computed tomography venography

Used to define status of iliac veins.