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Chapter 19: Ultrasound Evaluation and Mapping of the Superficial Venous System

Overview

• Focus on the anatomy and mapping procedures of the superficial venous system

• Common reasons for evaluation include DVT checks and planning for bypass procedures

Superficial Venous System and Its Role

• The greater saphenous vein (GSV) and small saphenous vein (SSV) are primarily used for surgical bypasses due to their superficial nature.

• Ablation procedures may be performed to eliminate varicosities or relieve ulcers in the leg.

• Indications for mapping include:

  • Anatomical variations in superficial veins

  • Identification of pathology such as thrombus or valve issues

Techniques in Venous Mapping

• Duplex ultrasound is utilized for assessing the competency of superficial veins for use as bypass conduits.

• Gather essential information including:

  • Patency of the vein

  • Valve competency

  • Correct positioning, depth, size, and length of veins

• Proper mapping minimizes surgical dissection and optimizes procedure outcomes.

Anatomical Considerations

• **Terminology:

  • Greater Saphenous Vein (GSV): formerly known as long saphenous vein (LSV)

  • Small Saphenous Vein (SSV): formerly lesser saphenous vein (SSV)

  • Accessory veins include the anterior and posterior accessory saphenous veins.**

• Anatomy of the GSV:

  • Lies in the saphenous compartment bounded by muscular and saphenous fascia.

  • Important landmarks include hyperechoic areas surrounding the vein and the Egyptian eye reference point.

Configuration Variants

• Common GSV configurations include:

  • Singular trunk with large tributaries

  • Single trunk patterning anterior or laterally

  • Variable degrees of duplication and partial double systems

• The GSV usually courses medially down the thigh to the ankle, while the SSV generally tracks along the posterior calf.

Key Information for Mapping

• Common femoral vein (CFV) and saphenous-femoral junction are critical connections for the GSV.

• Mapping should delineate:

  • Diameter and any potential variations (double systems or tributaries)

  • Document any identified perforating veins and their sizes.

  • GSV and SSV must be devoid of any thrombus for optimal use.

Patient Preparation

• Patients should avoid lotions or powders to enhance contact during ultrasound.

• Positioning should encourage venous filling; elevate legs slightly to enhance flow.

• Utilize non-sterile covers for probes to avoid contamination.

Important Protocols and Documentation

• Continuously document vessel diameter, thrombosis, and anatomical variations along the length of the veins from groin to ankle.

• For GSV mapping, mark tributaries, perforators, and diameter at various intervals to aid surgical planning.

Diagnostic Ultrasound Criteria

• Assess for:

  • Patency and flow direction in veins

  • Measuring diameter at proximal, mid, and distal points.

  • Abnormalities including thrombus, hypoechoic changes, or structural irregularities.

Understanding Venous Disorders

• Thrombus may be found in superficial veins and needs careful interpretation—often these are chronic.

• Varicosities signify valvular insufficiency and dilation connected to increased venous pressure.

• Recanalization presents as irregular thickening of walls and is generally inadequate for bypass.

Clinical Case Examples

• Use of imaging to observe and document the GSV under various conditions, including thrombus presence or healthy vein flow.

• Examination of the SSV confirms its consistent pattern and its eventual termination at the popliteal vein.

Conclusion

• Mastering the anatomy and techniques for mapping superficial veins is crucial for guiding clinical decisions for venous interventions.

• Continued practice in the lab enhances proficiency in identifying and mapping the venous system.