| Tests | Anatomy | Duplex Ultrasound Imaging | Reflux Assessment | Perforator evaluation |
|---|---|---|---|---|
|
spectral doppler
color doppler valsalva proximal limb compression distal limb compression
What are the ways we evaluate valve competency?
|
Perforators of the femoral canal - formerly Dodd’s
Knee perforator Paratibial perforators - formerly Boyd’s Posterior tibial - formerly cockett’s
What are the perforator veins and their former names?
|
What is gray scale imaging, PW doppler, and a linear probe with 7.5-10 MHz.
Equipment required for duplex examination?
|
What is flow measured above the baseline during valsalva. Sharp upstroke demonstrating valve snap at the start of valsalva with the crease of flow during the reminding time of valsalva maneuver
How does venous insufficiency affect a patient’s PW doppler while performing valsalva? What will a normal PW look like?
|
What is dilated and allowing blood to flow in the incorrect direction
How will perforators act when incompetent?
|
|
The gold standard, invasive, identifies location, extent, and degree of attachment of the blood clots. It is expensive, uncomfortable, and expensive. Hematoma can cause a false positive in this test.
What is venography, what does it tell us, and what are it’s drawbacks?
|
What is superficial to deep?
normal flow in the lower extremity goes from….
|
What is not being able to show severity, and PW doppler is far more accurate
Why is color doppler unnecessary for evaluation of valve insufficiency?
|
What is >1.00 seconds
What is the cutoff for abnormal reflux duration?
|
What is from the superficial to the deep system
Which way do perforators direct blood in the lower extremity?
|
|
In descending venography, the dye is in injected in the contralateral CFV, and in ascending it is injected in the foot. Ascending looks for filling defects, descending is looking for fluoroscopy distal to the site of injection- aka the dye is DESCENDING. Descending venography is used to detect venous insufficiency, ascending is to detect a thrombus
How does descending venography differ from ascending venography and what is it for?
|
What is the AAGSV, anterior accessory GSV, long anterior circumflex vein or a duplicated GSV. Originates in GSV below SFJ and courses obliquely down anterior thigh, can rejoin GSV in the lower thigh
Very common anatomical variant in the lower extremities
|
What is set all parameters for low flow states, decrease wall filter, decrease PRF, use a high frequency transducer, position the patient in a reverse trendelenburg or standing position.
How do you optimize your exam while evaluation venous insufficiency?
|
What is .5 seconds
What number represents a significant amount of reflux?
|
What is flow above baseline first, then flow below the baseline with augmentation
How will valve reflux present with calf augmentation?
|
|
What is a 45° upright, non-weight bearing position?
What position are patients situated in for venography exams?
|
What is the fascia line?
What do perforators cut?
|
high blood volume, causing an increase in pressure - venous hypertension
Distal to an incompetent valve, venous reflux will cause
|
What is pulsatility?
what will reflux not affect in a PW reading?
|
Scan the course of GSV and LSV & then follow any observed perforators
scan the fascia on the medial and posterior calf
2 methods of perforators evaluation?
|
|
What is duplex ultrasound?
What is the primary diagnostic tool for diagnosing superficial venous insufficiency?
|
What is the Giacomini vein?
Former name of the small saphenous vein?
|
Venous hypertension
When the patient with venous insufficiency is standing, what is at its highest?
|
Make the patient stand and evaluate CFV, SFV, Pop, GSV, LSV, and perforators.
When the patient’s reading is normal but they are symptomatic how should you change their positioning?
|
away from transducer is normal for perforators in lower extremity
reflux greater than .35 seconds is considered abnormal
refer to picture to evaluate flow of perforator
What is considered an abnormal level of reflux in perforators? |
Support Us on Ko-fi