Lower Extremity Venous Abnormalities

What are the symptoms of venous disease?

1. Pain

2. Swelling or edema

3. Rubor, redness, or hyperpigmentation (brawny disolorization)

4. Warmth

5. Venous HTN

6. Ulcers

What is the Homan sign?

Pain experienced with quick dorsiflexion of foot seen in those with DVT

What is a deep vein thrombosis (DVT) of the lower extremity?

Thrombosis of deep veins that most commonly originate at calf in soleal sinuses

What is the most reliable finding for a DVT diagnosis?

Lack of compressibility

What is the sonographic appearance of an acute DVT?

1. Grayscale shows a non-compressible and dilated vessel lumen

2. Grayscale shows an anechoic structure with poor wall attachment filling lumen

3. Color shows no color fill

4. PW shows no or minimal venous flow

Identify this image.

Acute DVT

What is the sonographic appearance of a chronic DVT?

1. Grayscale shows a non-compressible and retracted vessel lumen

2. Grayscale shows an echogenic or hyperechoic structure with strong wall attachment lining lumen

3. Grayscale shows echogenic vein walls

4. Color shows partial color fill

5. PW shows continuous or normal venous flow

Identify this image.

Chronic DVT

What is Virchow’s Triad?

Main factors contributing to DVT that include

• Trauma due to injury or drug usage

• Stasis due to bed rest or pregnancy

• Hypercoagulability due to cancer, oral contraceptive use, or polycythemia vera

What is the treatment for DVT?

DVT in deep leg veins veins are treated aggressively

• Bedrest

• Lovenox shot

• IV heparin to stop clot progression

• Coumadin, Warfarin, Xarelto, or Eliquis therapy for 3-6 months

What is a Greenfield filter?

Umbrella-like device inserted in IVC below renal veins to prevent embolisms from reaching lungs in patients with history of multiple DVTs

What is venous bypass?

Procedure used to treat ilio-femoral venous obstruction

• Left obstruction: Flow moves left to right in graft

• Right obstruction: Flow moves right to left in graft

What lab values are associated with DVT?

D-dimer > 500 ng/ml

What is D-dimer?

Test that can indicate DVT

What can cause increased D-dimer levels?

1. Pregnancy

2. Malignancy

3. Recent surgery

4. Trauma

What are the characteristics of a venous ulcer?

1. Not painful

2. Shallow ulceration

3. Wet and oozing

4. Located near medial malleolus or GAITER ZONE

What is May Thurner syndrome?

When right iliac artery compresses left iliac vein and causes extensive DVT

What is superficial phlebitis or thrombophlebitis?

Inflammation of vein walls with or without thrombus

Identify this image.

Superficial phlebitis or thrombophlebitis seen as increased vascularity around vessel walls

What is superficial venous thrombosis?

Thrombosis of superficial vein due to valvular insufficiency or patient inactivity

What is the treatment for a superficial venous thrombosis?

Less aggressive

• Anti-inflammatory drugs

• Support stockings

• Warm compress

• Limb elevation

What is phlegmasia cerulea dolens?

Extensive thrombosis occluding deep AND superficial system due to MALIGNANCY

What are the symptoms of phlegmasia cerulea dolens?

1. Cyanotic skin due to high concentration of deoxygenated blood

2. Severe limb swelling

3. Edema

What is phlegmasia alba dolens?

Extensive thrombosis that ONLY affects deep system due to PREGNANCY

What are the symptoms of phlegmasia alba dolens?

1. Milky white skin due to reduction in arterial flow

2. Swelling

3. Pallor

4. Pain

What is cellulitis?

Bacterial infection of skin that causes skin to be red and warm

What is a Baker’s cyst?

Encapsulated synovial fluid in medial popliteal fossa due to chronic knee joint dysfunction

Identify this image.

Baker’s cyst

What is the most common complication of DVT?

Post phlebitic syndrome (80%)

What is post phlebitic syndrome?

When DVT resolves, but there is damage to vein and valves causing reflux

What is the most significant complication of DVT?

Pulmonary embolism

What is a pulmonary embolism (PE)?

When thrombus breaks loose and travels through heart to lungs