Chapter 17: Duplex Ultrasound Imaging of the Lower Extremity Venous System Flashcards
(130 cards)
1
Q
Newly formed clotted blood within a vein, generally less than 14 days old
A
acute thrombus
2
Q
residual material present within a vein for a period of several weeks or months; also called chronic change, scarring
A
chronic post-thrombotic changes
3
Q
a vein that is the companion vessel to an artery and travels deep to the muscular fascia and lies within the deep muscular compartments of the leg
A
deep vein
4
Q
a small vein that connects the deep and superficial venous systems
A
perforating vein
5
Q
a vein that is superficial to the muscular fascia and the muscular compartments of the leg; travels within superficial fascial compartments; has no corresponding companion artery
A
superficial vein
6
Q
an inward projection of the intimal layer of a vein wall producing two semilunar leaflets, which present the retrograde movement of blood flow
A
valve
7
Q
Well’s criteria high probabality of DVT
A
more than 3 points
8
Q
Well’s criteria intermediate probability of DVT
A
1-2 points
9
Q
Well’s criteria low probability of DVT
A
0 points
10
Q
thrombus poorly attached to vein wall; may be free floating
A
acute thrombus
11
Q
Spectral and color Doppler signals complete thrombus
A
none
12
Q
thrombus fully attached to vein wall
A
chronic post-thrombotic changes
13
Q
veins will partially compress but not able to completely coapt walls
A
partial nonocclusive thrombus
14
Q
Venous ultrasound used to assess three main things:
A
presence of absence of thrombus
appearance of thrombus
competence of contained valves
15
Q
3 main categories of veins that can be imaged:
A
deep veins
superficial veins
perforating veins
16
Q
main conduit for blood returning to the heart
A
deep veins
17
Q
travel close to skin, superficial to muscle
A
superficial veins
18
Q
What is the purpose of superficial veins?
A
get blood near skin to help regulate body temperature
19
Q
small veins that connect deep veins with superficial veins
A
perforating veins
20
Q
move blood from superficial veins to deep veins where blood can be pumped back to heart by muscular contractions
A
perforating veins
21
Q
Leading cause of preventable death
A
venous thromboembolism
22
Q
most common mechanisms for the formation of venous thrombosis
A
Virchow Triad
23
Q
Virchow Triad
A
venous stasis
vessel wall injury
hypercoaguability
24
Q
allows for increased exposure of clotting factor occurs in immobility
A
venous stasis
25
affect body's normal thrombolytic system
cather related
trauma
vessel wall injury
26
associated with: cancer, birth control pills, hormone replacement therapy
hypercoaguability
27
very commonly begin in soleal sinus veins in calf or around small valve cusps in calfs because areas of slower flow may cause areas of stagnation
deep venous thrombus
28
Signs and symptoms are caused by:
venous obstruction
vascular and perivascular inflammation
embolization of thrombi
29
breakdown product of fibrin, which will be elevated in presence of DVT
D-dimer
30
What position works best for sonographic examination?
reversed Trendelenburg
31
What is the reversed Trendelenburg position?
patient lie flat on back, knees slightly bent, hips slightely externally rotated, head 20 degrees
32
Transducer that best images femoral, popliteal, most of calf, subclavian, and larger arms
linear array 5- 10 MHZ transducer
33
Transducer that best images superficial veins and most of arm veins; used in detailed reflux mapping and mapping
10-18 MHz linear array transducer with small footprint
34
transducer that best images IVC and iliac veins as well as deeper lying veins in bigger patients
curved linear array 2-5 MHz
35
A sonographer should compress a vein every __-__ cm throughout leg.
2-3
36
Where is the EIV located?
at the level of the inguinal ligament
37
Where is the CFV/GSV located?
medial direction in groin crease
38
large and longest superficial vein in the body
greater saphenous vein
39
The GSV terminates into the CFV at the _______ junction
saphenofemoral
40
The CFV is formed by the junction of the ___ and ____.
FV
DFV
41
The FV is more ____ than the DFV.
superficial
42
main venous outflow of the calf
Femoral vein
43
mainly drains thigh
DFV
44
located distal to the adductor canal
popliteal vein
45
main drainage for blood leaving the calf
popliteal vein
46
terminates into popliteal vein in mid to upper regions of popliteal fossa
anterior tibial vein
47
Why are thrombi rare in the anterior tibial veins?
do not communicate with primary source of thrombi in leg- soleal sinus veins
48
primary source of thombi in leg
soleal sinus veins
49
drain gastrocnemius muscles
gastrocnemius veins
50
superficial vein; terminates into popliteal vein at about same level as gastrocneumius veins
small saphenous viens
51
terminus of the SSV into popliteal vein
saphenopopliteal junction
52
when SSV bypasses popliteal vein and continues up to posterior thigh of GSV in thigh
cranial extension of SSV
53
merge together to form fibioperoneal trunk
common posterial tibial and common peroneal vein
54
Paired PTVS unite to form:
common posterior tibial trunk
55
paired peroneals unite to form:
common peroneal trunk
56
paired and positioned alongside posterior tibial artery
posterior tibial veins
57
lie adjacent to fibula; parallel to the PTVs through most of the calf
Peroneal veins
58
major storage areas for blood in calf
soleal sinus veins
59
common site for thrombi to form
soleal sinus veins
60
Normal venous walls
thin and smooth
61
slight dilatations in vein wall
valve sinuses
62
thin white structures within sinus freely moving in bloodstream
valve leaflets
63
Spectral Doppler should show _____ signals within all normal major vessels
spontaneous
64
The waveform of a normal vein should be ____ with respiration.
phasic
65
Signals should _____ with proximal compression or Valsalva maneuver
cease
66
composed of a mixture of fibrin and red blood cells with platelets and acute inflammatory cells; heterogeneous echoes
acute thrombus
67
may demonstrate a tip or tail that appears to be free-floating
acute thrombus
68
strands of material within vein lumen; scarring; wall-thickening
chronic post-thrombotic changes
69
volume of thrombus shrinking
thrombus contraction or relaxation
70
surface characteristics of chronic post-thrombotic changes
irregular
71
thin strands with a weblike appearance in vein lumen
synechaie
72
important descriptors for thrombus
size of vein
surface characteristics
compressability and deformability
free-floating or firmly attached
73
flow that lacks respiratory phasicity and does not cease with proximal compression or Valsalva
continuous
74
flow in lower extremity veins both antegrade and retrograde
venous reflux/ venous insufficiency
75
Which category of veins are the main conduit for blood, are surrounded by muscle, and have an accompanying artery?
deep veins
76
What is the main function of the superficial venous system under normal conditions?
to help regulate body temperature
77
In which way do valves in perforating veins ensure that blood moves, under normal conditions?
from the superficial to the deep system
78
From epidemiologic studies, what percentage of patients develop postthrombotic symptoms?
30%
79
Which limb of Virchow's triad is demonstrated by a venous thrombus that starts at a valve cusp?
stasis
80
A patient presents to the vascular lab for lower extremity venous evaluation. The patient has known Factor V Leiden genetic factor. Under what risk factor of Virchow's triad does this patient fall?
hypercoaguability
81
Many patients with venous thrombosis are asymptomatic; however, when symptoms occur, what are some of the most common?
extremity pain, tenderness, and swelling
82
What would a high probability for DVT correspond to on Well's score?
>3 points
83
When can a false-negative D-dimer be seen in the presence of a DVT?
assay cannot detect low levels of fibrins
84
For routine operation of a vascular lab, the use of a high-frequency linear transducer ( 10-18 MHz) is recommended for the evaluation of which of the following?
a. superficial vein reflux
b. perforators
c. distal femoral vein
d. iliac veins
a
85
Why will using a reverse Trendelenburg position to examine the lower extremity venous system make the exam more difficult?
veins without thrombus will be harder to compress
86
What is the primary method used to determine the presence of thrombus in the extremity veins?
transducer compression of the veins
87
Which of the following is NOT a normal qualitative Doppler feature evaluated in the lower extremity venous system?
a. continuity of signal
b. spontaneity of signal
c. phasicity of signal
d. augmentation of signals
a
88
Which of the following large deep veins are commonly bifid?
a. the profunda and popliteal veins
b. the femoral and popliteal veins
c. the external iliac and femoral veins
d. the common femoral and popliteal veins
d
89
Which vessels are NOT routinely evaluated in a lower extremity venous duplex examination?
A. Femoral vein
B. Great saphenous vein
C. Anterior tibial veins
D. Small saphenous vein
C
90
Which veins are one of the major blood located in the calf?
A. The tibial veins
B. The small saphenous vein
C. The soleal sinus vein
D. The popliteal vein
C
91
What do intraluminal echoes that are rigid, well attached to the vein wall, and have an irregular surface suggest?
Chronic postthrombotic changes
92
In what case will indirect assessment of the iliac veins and IVC using Doppler at the common femoral veins suggest evidence of obstruction?
A. The Doppler spectrum exhibits phasicity
B. The Doppler spectrum exhibits pulsatility
C. The Doppler spectrum exhibits continuity
D. The Doppler spectrum ceases with Valsalva
C
93
During a lower extremity venous duplex examination, a thin, white structure is noticed moving freely in the lumen of the vein. What does this most likely represent?
Valve leaflet
94
95
Which veins are one of the major blood reservoirs located in the calf?
A. The tibial veins
B. The small saphenous vein
C. The soleal sinus vein
D. The popliteal vein
C
96
What do intraluminal echoes that are rigid, well attached to the vein wall, and have an irregular surface suggest?
Chronic postthrombotic changes
97
In what case will indirect assessment of the iliac veins and IVC using Doppler at the common femoral veins suggest evidence of obstruction?
The Doppler spectrum exhibits continuity
98
During a lower extremity venous duplex examination, a thin, white structure is noticed moving freely in the lumen of the vein. What does this most likely represent?
Valve leaflet
99
Which of the following is a normal response to venous flow with a valsalva maneuver?
A. Augmented flow
B. Phasicity of flow
C. Continuous flow
D. Cessation of flow
D
100
A patient presents to the vascular lab with sudden onset of left lower extremity pain and swelling. Upon duplex examination, poorly attached Echogenic material is noted within a dilated femoral vein, and the femoral vein does not compress with applied transducer pressure? What do these findings suggest?
Acute deep venous thrombosis
101
When a patient presents with right heart failure, what impact is often observed in the spectral Doppler waveform in the lower extremities?
Increased pulsatility
102
A patient presents to the emergency department with a massively swollen right lower extremity which is extremely painful and bluish in color. What do these findings suggest?
Phlegmasia cerulea dolens
103
Which treatment option is typically reserved for emergent situations in larger veins of the iliofemoral region?
A. Heparin
B. Coumadin
C. Elastic stockings
D. Thrombolysis
D
104
What is the primary treatment of acute lower extremity deep venous thrombosis?
Anticoagulation
105
Duplex ultrasound for the evaluation of the deep and superficial venous system has largely replaced _______ for the detection of DVT.
Radio graphic contrast venography
106
Duplex ultrasound has the capability to diagnose, localize, and determine the relative age of _____.
Thrombus
107
The primary mechanism for the formation of venous thrombosis which includes venous stasis, vessel wall injury, and a hypercoaguable state is known as _____.
Virchow triad
108
The fact that DVT is often undiagnosed or undiagnosed is likely because DVT is frequently _____.
Asymptomatic
109
The development of venous thrombosis is determined by a balance between clotting factors and _______.
Coagulation inhibitors fibrinolytic system
110
Tachypnea, tachycardia, and chest pain are often signs of _______.
Pulmonary embolism
111
A palpable cord along the medial aspect of the lower extremity would be a clinical sign for ______.
Superficial venous thrombosis
112
A patient with localized tenderness with limb swelling and a recent history of major surgery would score _____ points based on Wells criteria.
>3
113
The clinical diagnosis of DVT has _____ sensitivity and specificity
Poor
114
Appropriate positioning of the patient for a lower extremity venous evaluation includes having the patient lie on their back with their knee slightly bent and hip ______ rotated.
Externally
115
The evaluation of the IVC and iliac veins in most adult patients would require the use of a ______ transducer.
Curvilinear
116
The position described as the tilting of the exam table during a venous examination so that the legs are approximately 20 degrees lower than the upper body is called ______.
Reverse trendelenburg
117
Transducer compression of the extremity veins should NOT be performed in a _______ plane as it is easy to roll off the veins from this approach.
Longitudinal
118
The junction of the great saphenous vein within the common femoral vein usually occurs ______ to the bifurcation of the superficial and deep femoral arteries.
Proximal
119
The main venous outflow for the calf is the _____.
Femoral vein
120
The extension of the small saphenous vein above the popliteal fossa is referred to as the _____ extension of the small saphenous vein.
Cranial
121
It is not unusual for the ________ vein to share a common trunk with the gastrocnemius vein.
Small saphenous
122
The posterior tibial and peroneal veins typically communicate with the _______ veins.
Soleal sinus
123
The only way to adequately image the content of the venous lumen to exclude DVT when performing compression is to view the vessel in ______
Transverse
124
The process of a thrombus continuing to shrink and fill less of the vein can be known as ______.
Recanalization
125
When using Doppler, if there is a thrombosis between the level of the transducer and the site of distal compression, the result will be _________ with the compression.
No augmentation
126
Unilateral pulsatile venous flow can be associated with _______.
Arteriovenous fistulae
127
Compression of the left common iliac by the right common iliac artery can result in _______ syndrome.
May Thurner
128
A no vascular, anechoic, well-defined, oval mass found incidentally during a lower extremity venous duplex evaluation most likely represents a(n)
Cyst
129
Computed tomography venography and magnetic resonance venography are often used to evaluate the status of the _____ veins.
Iliac
130
