Chapter 21: Sonography in the Venous Treatment Room

Question 1

a long-lasting valvular or obstructive disorder of the veins

Answer 1

chronic venous insufficiency

Question 2

destruction of the vein by various means

Answer 2

endovenous ablation

Question 3

anesthesia that placed around the vein to be treated with thermal ablation under ultrasound guidance

Answer 3

perivenous (tumescent) anesthesia

Question 4

physician who is specialized in the diagnosis and treatment of vein disorders

Answer 4

phlebologist

Question 5

retrograde flow upon release of distal compression in standing patient

Greater than 0.5 seconds in the superficial venous system

Greater than 1.0 second in deep venous system

Answer 5

reflux

Question 6

a chemical irritant used in the treatment of varicose veins, resulting in inflammation and subsequent fibrosis, thus obliterating the lumen of the vein

Answer 6

sclerosant

Question 7

a medical procedure involving an injection of a sclerosant into the vein; may be performed visually or under ultrasound guidance.

Answer 7

sclerotherapy

Question 8

Gold standard method for assessment of veins

Answer 8

Duplex ultrasound

Question 9

What is the overall goal of venous ultrasound studies?

Answer 9

assess venous system hemodynamics

Question 10

Traditional way to treat CVJ and specifically superficial venous disease

Answer 10

Vein stripping and ligation

Question 11

Surgical removal/ destruction of veins. Typically performed on the inside of veins

Answer 11

Ablation

Question 12

surgical procedure in which a small incision is created next to the varicosity and a special instrument is employed to hook the vein and extract it

Answer 12

ambulator phlebectomy/microphlebectomy

Question 13

a sonographer who has thorough knowledge of venous anatomy and hemodynamics

Answer 13

Registered Phlebology Sonographer

Question 14

physician who is specialized in the diagnosis and treatment of venous disorders

Answer 14

phlebologist

Question 15

first assistant in interventional room

Answer 15

sonographer

Question 16

Complications of misplacing endovenous thermal device

Answer 16

ablation of EIV and CFV

Question 17

Complications of misplacing chemical sclerosant into popliteal artery

Answer 17

loss of limnb

Question 18

primary role of sonographer in interventional room

Answer 18

provide ultrasound guidance

Question 19

For a microphlebectomy or vein extraction, the patient should remain standing for ____ minutes to ensure maximum distention of any superficial veins

Answer 19

5-10

Question 20

Patient position for GSV or AAGSV ablation

Answer 20

supine, head slightly elevated, leg externally rotated, knee slightly bent

Question 21

Patient position for SSV ablation

Answer 21

prone, pillow under feet

Question 22

The tumescent anesthesia needle is __ cm long

Answer 22

10

Question 23

Why is it important to evaluate for presence of any large tributaries or perforating veins?

Answer 23

increased risk of incomplete ablation or subsequent recanalization at the point where vessels intersect

Question 24

Notable thickened wall veins when mapping veins can be from _____.

Answer 24

vasospasm

Question 25

What is "flash"

Answer 25

blood return in syringe

Question 26

Failure to position device properly can result in:

Answer 26

endovenous heat-induced thrombosis deep vein thrombosis thermal ablation of deep vein itself

Question 27

A patient should have a follow up ultrasound ____ postprocedure

Answer 27

2-7

Question 28

The goal of ________ is to distribute sclerosant volume to diseased vein(s)

Answer 28

ultrasound guided sclerotherapy

Question 29

Which of the following are reasons why traditional surgical stripping and high ligation are rarely performed? a. invasive and painful procedure b. requires general anesthesia c. prolonged recovery requiring weeks to months d. all of the above

Answer 29

d

Question 30

What is the surgical procedure in which a small incision is created next to a varicosity and a spectral instrument is used to hook and extract the vein?

Answer 30

ambulatory phlebectomy

Question 31

Which of the following is a credential that can be earned to demonstrate a thorough knowledge of venous anatomy and hemodynamics? a. ARNP b. RPhS c. RCS d. RVT

Answer 31

b

Question 32

What is the primary role of the sonographer in the intervention room during venous treatment?

Answer 32

provide ultrasound guidance

Question 33

Which of the following would be a critical step in preparing the patient for a venous treatment procedure? a. documenting the patient's clinical condition b. verifying the correct leg and vein to be treated c. scheduling a postoperative appointment d. explaining the venous disease process

Answer 33

b

Question 34

When the small saphenous vein is being treated, what is the most common patient position used to ensure access to this vein?

Answer 34

prone

Question 35

Because of the location of most of the veins that will be evaluated in the intervention room, what are the typical transducer frequencies that will be used?

Answer 35

high frequency

Question 36

While providing ultrasound guidance, what is indicated by a vein that has a notably thickened wall and a reduced lumen diameter?

Answer 36

vasospasm

Question 37

What is the advantage of viewing the access needle in a longitudinal plane rather than transverse?

Answer 37

needle can be more easily advanced directly under the transducer

Question 38

What is the term for blood that is returned through the needle when assessing a vein?

Answer 38

flash

Question 39

Where should the guidewire be located?

Answer 39

intraluminally in the vein to be treated

Question 40

What landmark should be used to ensure the tip of the treatment device is positioned appropriately in the great saphenous vein?

Answer 40

superficial epigastric vein

Question 41

Which structure is near the saphenopopliteal junction and can be injured by the treatment device?

Answer 41

sciatic nerve

Question 42

One the treatment device is in place, what position should the patient be placed in before treatment begins, ensure the veins empty and contract around the device.

Answer 42

Trendelenburg

Question 43

Which imaging plane is typically preferred for guidance of placement of tumescent anesthesia?

Answer 43

longitudinal

Question 44

After placing the tumescent anesthesia, what is the minimum separation between the treated vein and the skin line?

Answer 44

1-2 cm

Question 45

What would a hyperechoic echo actively forming as the thermal ablation device is being withdrawn represent?

Answer 45

destruction of endothelial lining

Question 46

When should initial follow up occur after a patient has had a thermal ablation?

Answer 46

2 to 7 days postprocedure

Question 47

Which of the following is typically applied to the patient's leg postablation procedure? a. small bandages over incision sites and graduated compression stockings b. small bandages over incision sites and nothing else c. soft; supportive cast d. absorbent pads and bandages over incision sites

Answer 47

a

Question 48

The invasive, surgical, traditional treatment of chronic venous insufficiency is known as vein ______

Answer 48

stripping and high ligation

Question 49

Current minimally invasive techniques for treatment of chronic venous insufficiency are largely performed under ultrasound ______ in order to place needles, devices, and drugs.

Answer 49

guidance

Question 50

Treatment of bulbous tributaries, smaller varicosities, reticular veins, and telangiectasis typically involves _______ ablation.

Answer 50

endovenous thermal or chemical

Question 51

A complication that may result during thermal ablation or administration of perivenous anesthesia because of a needle piercing both an artery and a vein is a(n) ______

Answer 51

arteriovenous fistula

Question 52

If a patient is scheduled for micro-phlebectomy, it is recommended that they remain standing for _____ minutes to ensure maximum distention of superficial veins.

Answer 52

5-10

Question 53

While in the intervention room, ultrasound evaluation is primarily a(n) ______ process.

Answer 53

imaging

Question 54

In preparation for an ablation procedure, many centers will _____ the vein to be treated so that it can be easily identified and followed.

Answer 54

mark

Question 55

A patient who is cold, dehydrated, or apprehensive about the interventional procedures may have veins that are in _____.

Answer 55

vasospasm

Question 56

To maintain a sterile field during an ultrasound-guided procedure in the intervention room, the ultrasound transducer is place in a(n) ______.

Answer 56

sterile sheath

Question 57

When gaining access to the vein for treatment, it is preferable to access below any larger _______ or isolate their connection with truncal veins.

Answer 57

tributaries

Question 58

To help induce vasodillatation, heat or _______ can be applied.

Answer 58

micropaster

Question 59

A difference between thermal ablation and adhesive ablation is that with adhesive ablation, transducer or manual ______ must be applied to collapse the vein in order to limit proximal progression of the adhesive.

Answer 59

compression

Question 60

Encountering a valve or small tortuosity can cause ______ when advancing the catheter or treatment fiber.

Answer 60

resistance

Question 61

When treating the small saphenous vein, the treatment device should not be advanced out of the _____.

Answer 61

small saphenous compartment

Question 62

On the ultrasound image, the tumescent anesthesia appears as a(n) ________ "cocoon" of fluid encircling the vein.

Answer 62

hypoechoic

Question 63

If the thermal ablation catheter is too close to the skin line, superficial _______ can occur and be permanent.

Answer 63

skin burns

Question 64

Pressure should be applied over a thermal ablation device to ensure that the vessel walls are _____ and in contact with the device.

Answer 64

coapted

Question 65

Particulary large venous segments or connections with large tributaries warrant additional _____ and increased transducer pressure to ensure adequate closure.

Answer 65

energy

Question 66

To ensure a sclerosing agent completely fills the varicosities, the ______ from the cluster of treated vessels should be identifited.

Answer 66

primary outflow

Question 67

Adequate dispersion of a sclerosant can be accomplished by applying pressure or "_____" the tissues to move the sclerosant in the desired direction.

Answer 67

milking