Ch 8 Venous Valvular Testing Flashcards by Sarah Anderson

What is the anterior GSV?

Superficial vein at the anterior thigh

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What does CEAP stand for?

Clinical, etiologic, anatomic, pathophysiologic (classification of venous disease)

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What is chronic venous insufficiency?

Long lasting venous valvular or obstructive disorder

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What is elastic compression?

The effects of stockings used to compress the leg, with intent to compress the veins

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What is lipedema?

Swelling of fat tissue

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What is plethysmography?

-Graphic presentation of pulses
-It measures changes in volume in different parts of the body

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What is reflux?

Reverse flow, m/c in veins with incompetent valves

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What is a reticular vein?

Superficial vein less than 3mm

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What is a spider vein?

-Small clusters of veins near the skin surface that are red, blue or purple + measure b/w 0.5-1mm
-Aka telangiectasias

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What is a tributary vein?

Vein that terminates/empties into another larger vein

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Measurement for a varicose vein?

> 3mm

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What is the vein of giacomini (VOG)?

Extension of SSV to GSV within a saphenous fascia

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What is CVVI?

-Chronic venous valvular insufficiency
-Occurs in deep or superficial veins with incompetent valves + reflux

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Do most pt’s with CVVI have venous obstruction?

No!

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Which vein is the primary concern in CVVI?

GSV

(easily seen at the groin/SFJ as the medial mickey mouse ear OR in the thigh bordered by the deep + superficial fascia creating the egyptian eye look)

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GSV hypoplasia/agenesis is common where?

Below the knee

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Differentiate b/w true GSV duplication + superficial/accessory veins?

True: 2 veins staying within saphenous part

Superficial/Accessory: coursing in + out the saphenous part

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The prox GSV has 2 major valves, what are they?

-Terminal valve (0.4cm from SFJ)
-Preterminal valve (3.1cm from SFJ)

The SFJ tributaries join the GSV b/w what valves?

The terminal + preterminal valves

What is AAFSV?

Anterior accessory GSV (is anteromedial in thigh + empties into SFJ)

What is PAGSV?

Posterior accessory GSV (lies deep to GSV in thigh)

The m/c SSV termination is where?

At the Pop V via the SPJ

(note there are 3 other SSV variations)

What is the function of persistent sciatic veins?

-Functions as collateral pathways for the FV
-The sciatic vein is deeper in the thigh + adjacent to the sciatic nerve

What is venous valvular insufficiency testing?

Venous reverse flow (reflux) detection

Explain the anatomy behind valves?

-Unidirectional -More valves with distance away from the heart -Open with contraction, close with relaxation

Incompetent valves cause abnormal retrograde flow/reflux, what does this cause?

An increased volume of blood in the lower leg

List the 3 types of disorders that affect LE venous bicuspid valves?

Valve agenesis: is congenital (reflux occurs at any time) Valve damage: caused by DVT or degeneration due to age (reflux occurs at any time) Valve leakage: due to venous dilatation, the vein is too big for the valve to close properly (reflux occurs intermittently)

What 2 things are varicose veins associated with?

Valve reflux + venous obstruction

List the clinical CEAP classification?

C0: no signs/symptoms C1: spider or reticular veins (<3mm) C2: varicose veins (>3mm) C3: edema C4: skin changes C5: healed skin ulcers C6: open skin ulcers (view chart in slides for full CEAP)

What is VCSS?

-Venous clinical severity score -Used to assess those with venous disease that is complementary to the CEAP classification (score varies b/w 0-30)

U/s exam for CVVI has what 2 key diagnostic goals?

-To exclude deep venous obstruction or acute thrombosis -To evaluate the function of valves, or reflux detection

What is the pt prep for valvular testing?

-Get pt to remove clothes from waist down -Deep veins are imaged first in reverse trendelenburg -Superficial veins are imaged while pt stands

Is detecting acute DVT rare?

Yes!

Normal antegrade flow should be ___ the baseline?

Below

Abnormal retrograde flow should be ___ the baseline?

Above

What does the valsalva maneuver test?

Reflux in the CFV + prox GSV, at the SFJ (does not test more distal veins)

What does the parana maneuver test?

Valves above + below knee (calf muscle must pump)

What do foot flexion + toe curls do?

Causes calf muscle contractions

What do hand compressions do?

The tech can squeeze the distal leg being tested for a variety of conditions

Chronic venous valvular insufficiency (CVVI) may present with an increase in what?

Collateral vein diameters, but the veins are still completely compressible

How will the valves + affected veins appear with CVVI on 2D?

Valves: Thickened leaflets Veins: tortuous, varicose or aneurysmal

How will CVVI appear on spectral doppler + CD?

SD: Reverse/reflux flow seen following prox or distal compression CD: Retrograde turbulent flow within valve sinuses

How fast does the saphenous, deep femoropopliteal + perforating vein valves close?

Saphenous: <0.5 sec Deep FP: <1 sec Perforating: <0.35 sec (longer duration's = abnormal reflux)

Treatment options for superficial CVVI?

Traditional: Ligation with or w/o stripping + phlebectomies Present: Sclerotherapy (chemical ablation), thermal ablation + cyanoacrylate glue occlusion (ablation has replaced stripping + ligation)