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RVT Review > Chapter 28 > Flashcards

Chapter 28 Flashcards

1
Q

what are capabilities with peripheral vein duplex imaging?

A

identify venous thorbosis (acute vs chronic)
evaluate non - occluding /partial thrombus
detect calf lesion
distinguish between extrinsic compresion and intriscic obstruction
evaluate soft tissue masses
detect venous incompetence
document recanalized channels or collateralization

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2
Q

what are capabilites with abdominal / pelvic veins with duplex imaging?

A

assist with documenting elevate systemic venous pressur eidentify venous throbosis
evaluate patency of IVC interruption devices
assess portocaval shunts
evaluate of some liver diseases

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3
Q

what are limits of visulation in duplex imaging?.

A

edema, scarring, recent surgery, obesity

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4
Q

what are some sources of false positive?

A

extrinsic compression e.g tumores, ascites, pregnancy
PAD- decreased venous filling
chronic obstructive pulmonary disease- elevated central venous P
improper doppler angle or probe pressure
SVC syndrome

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5
Q

what are sources of false negative studies?

A

proximal obstruction

techneq limited studies

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6
Q

why may it be diff to evaluate infra-pop v

A

secondary to vessel size, depth and course

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7
Q

why may it be diff to evaluate sub and brachiocephalic. innominate veins

A

due to bony structures

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8
Q

why is it hard to evaluate abdominal veins

A

vessel depth and presence of bowel gas

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9
Q

what is patient positioning for lower extremity peripheral veins exams

A

faciliate venous filling ie reversed trendelenburg
diminish extrntiric compression e.g extreme LLD
for reflux testing: when the patient is standing, and bears weight on contralateral leg

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10
Q

what is patient positioning for upper extremity peripheral veins exams

A

supine or low folwers position

arm in pledge position

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11
Q

what is patient positioning for abdominal veins

A

supine with head slightly elevated
LLD with head of bed elevated slightly
reversed trendenburg
or whatever works

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12
Q

how do you maximize color fillings and flow patterns?

A

adjust color scale to detect slower velocities
change wall filters
increase color gains

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13
Q

what is another word for compressibility

A

coaptation

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14
Q

what should venous flow patterns look like

A

spontaneous
phasic
aug with distal compresision
aug with prox release /valsa

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15
Q

how is the CFV formed?

A

confluence of femoral and DFV

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16
Q

where should you begin scanning the CFV?

A

at the inguinal ligament
identify the CFA
should be free of thrombus
in trv should assess for complete compressbiliby of vein walls

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17
Q

T/F thrombosis of superfical system at or near deep system requires more aggressive treatment

A

true

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18
Q

what is the sapehnofemoral junction

A

where GSV joins CFV

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19
Q

what is formed from the confluence of FV and DFV

A

CFV

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20
Q

T/F at the distal third of thigh it may be difficult to compress the vein

A

true

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21
Q

what forms the pop v

A

confluence of anterior tibial vein and tibio-peroneal trunk

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22
Q

what other things should you evaluate near the pop fossa

A 
any cystic structures or masses, ie bakers cyst
muscular/gastro veins 
LSV 
veins of trifurcation
ATA
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23
Q

where should the probe be to evaluate the PTVS

A

between medial malleolus and achilles tendon

evaluate vessels along medial surface of calf

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24
Q

where does the ptv terminate

A

in tibio-peroneal trunk near the pop fossa

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25
Q

what is the location of peron v

A

evident a few cm prox to the malleolus
deeper than ptv
evaluate vessel along medial calf (with ptvs)

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26
Q

where does the peron v terminate

A

tibio-peroenal trunk

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27
Q

what is chronic venous insufficiency?

A

flow reversal, usually in repsonse to a vala maneuver or during prox manual compressions, indicates venous reflus

28
Q

what are method to identify reflux

A

spectral analysis: reversed venous flow lasting more than 1 second noted during prox compression manauever
color flow imaging: color changes noted during prox compression maneuver

29
Q

where can blood pressure cuffs be applied for reflux

A

applied distal to the transducer

30
Q

where will the IJv be

A

near CCA in neck
evaluate from mandible to where it joins subclav vein
transverse vein to evaluate compressibility

31
Q

how is the subclav vein formed?

A

cephalic and axillary veins
joins with IJV to form innominate vein bilaterally
evalued from supraclavicular approach
can usually be followed only to outer border of first rib (clavicle prevents further vis)
infraclavicular approach may be used to eval distal segment

32
Q

axillary vein

A

formed by confluence of the baslic and brachial v

evaluated with arm raised ie pledge position, and probe in axilla

33
Q

brach vein

A

formed by raidal and ulnar veins

location varies considreably from antecubital fossa to axilla

34
Q

radial and ulnar veins

A

formed by confluence of palmar arch veins

35
Q

where does the IVC and pelvic veins evaluation begins

A

at level of umbilicus

36
Q

where does other views of abdominal vessels begins?

A

trans view at xiphoid process

37
Q

where would you hear spontaneity of the veins

A

at all sites except PTVs

38
Q

what is phasicity

A

sound varies with repirations

39
Q

what happens to the phasicity lower extremities

A

increases with expiration and decreases with inspiration

40
Q

what happens to the phasicity upper extremities

A

decreases with expiration and increases with inspiration

41
Q

when will augmentation occur

A

with distal compression or proximal release

42
Q

what does augmentation with valva mean

A

reflux/ retrograde flow

43
Q

what is extrinisic compression

A

pressure on vessels from surrounding tissues and/or structure can cause abnormal patterns

44
Q

when will pulsatile venous flow pattern be evident

A

with fluid overload or CHF

45
Q

what may help compress a upper extrem vein that is hard to compress due to bony structures

A

a quick breath though pursed lips should collapse vein

46
Q

which veins may have pulsitile waveforms

A

subclav and innominate veins

aug with distal compress may not be evident

47
Q

which vessels will have phasic, bidirection/pulsatile doppler signals

A

IVC renal and hepatic

48
Q

what vessels will have minimally phasic, continuous doppler singal

A

portal, splenic and mesenteric veins

49
Q

what flow patterns will abd and pelvic veins have

A

dilatation with deep inspiration

spontaneous doppler signals

50
Q

T/F during inspiration there is minimal flow fluctuation in the portal vein, flow is variable in the hepatic vein

A

true

51
Q

what will happen with acute thrombosis

A

peripehral veins not compeltely compressible being filled with very low level echoes
visible thrombus may be evident
vessel is dilated
abnormal doppler signals

52
Q

if flow is not spontaneous at the CFV, FV, or Pop V an obstruction is where

A

distal to or at that site is suggested

may indicate a DVT or extrinisic compression

53
Q

if flow is not phasic but continuous where is the obstruction

A

proximal

54
Q

if no augmentation with distal compression is seen where is the obstruction

A

between where you are compressing and where you are listening. or slighly mor eproximally

55
Q

if there is no aug with proximal release, where is the obstruction

A

proximal

56
Q

if flow increases during proximal compression what does it signify

A

reflux

57
Q

what is rouleau formation?

A

very sluggish flow seen as heterogeneous material moving with respirations and aug manuevers
red blood cells arranged like rolls of coins or rouleau

58
Q

a compressible vessel with evidence of rouleu formation on B mode, could mean what

A

normal or suggest proximal oBstruction eg Dvt, increased central venous pressure, svc syndrome

59
Q

what are chronic changes to a vein

A

highly echogenic
visible collateraliztion or recanalization may be evident
vessel not dilated may retract over time
abnormal doppler venous signal may be evident eg continuous decrease phasicity, or no aug)
venous reflux lasting >0.5 or >1sec

60
Q

how will reflux look on color doppler

A

as a shift in color from flow away from probe to flow towards probe during the valsalva man and or following compression distal to the transducer

61
Q

where are IVC interruption devices placed

A

below renal veins and may appear as bright echogenic lines

62
Q

what will happen with systemic venous HTN

A

persistent dilated vessels evident

63
Q

what will happen with portal HTN

A

increased portal venous pressure can result in variety of flow alterations
reversed flow in portal vein hepatfugal
collateral development

64
Q

what is budd chiari syndrome

A

results from hepatic vein occlusion

primary site of obstruction may be hepatic vein, sinusoid, or ivc

65
Q

what are clinical findings with budd chiari

A

hepatomegaly, abdominal pain, sudden onset of ascites

RVT Review (30 decks)

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