Chapter 29

Question 1

what are capabilities of contrast venography?

Answer 1

still considered the gold standard but decreasign in numbers bc of duplex imaging

Question 2

what is ascending venography?

Answer 2

utilized for evaluation of acute DVT, congenital venous disease and/or anomalies, eva of chronic venous thrombosis

Question 3

what is descedning venography

Answer 3

used primarily to detect and quantify reversed flow from incompetent venous valves

Question 4

what are limitations for contrast venography?

Answer 4

highly technical in technique and interpreation
relatively expensive
uncomfy
adverse effects: allergic reations or extravasation of contrast media
may be contraindicated in patients with severe PAD secondary to risk of extravasation, and patients with allergies to iodine

Question 5

what is the tecnq for ascending venography?

Answer 5

radio-opaque contrast media injected into vein on dorsum of the foot to visulize anatomy
serial xrays taken as media passes through veins identifying filling defects, anatomic variations, develop of collateral channels

Question 6

what is the tecnq for descending venography?

Answer 6

radio-opaque contrast media injected into common femoral vein
serial xrays taken as material passes through veins to detect and quantify reversed flow and location of incompetent valves

Question 7

what are control risk factors related to virchow triad?

Answer 7

decrease venous stasis
prevent injury or infection
aware of hypercoagulability states/ factors

Question 8

what are some ways to decrease venous stasis?

Answer 8

limit long periods of inactivity or bed rest

promote venous drainage

Question 9

how can you promote venous drainage?

Answer 9

wear support hose or elastic stockings
elevate leg
intermittent pneumatic calf compression during and after surgery

Question 10

what is a type of prophylaxis?

Answer 10

heparin

Question 11

what does low dose heparin do?

Answer 11

interferes with formation of blood clot

does not lyse an existing thrombus

Question 12

what meds do they give for acute DVT and / or PE?

Answer 12

heparin: loading dose followed by continuous intravenous infusion for 5-10 days

coumadin: nearing end of heparinixation oral anticoagulation started
prescribed for 3-6 months

Question 13

what does lytic therapy do?

Answer 13

breakdown of thrombus ie hemolysis

Question 14

what are types of lytic therapy?

Answer 14

urokinase or streptokinase

Question 15

when someone has an acute iliofemoral DVT what meds do they give>

Answer 15

lytic therapy

urokinase or streptokinase

Question 16

how they treat venous ulcers?

Answer 16

medicated compression dressing e.g unna boot (profore 4 layer dressing)

Question 17

what is performed to prevent a PE in patients who cannot be anticoagulated?

Answer 17

vena caval interruption device

Question 18

how are vena caval interruption device placed?

Answer 18

using fluoroscopy, a filter placed in IVC via jugular or femoral vein
an external caval clip may be placed around IVC during abd surgery to decrease risk of PE

Question 19

what is iliofemoral venous thrombectomy?

Answer 19

performed for impending limb loss ie phlegmasia cerulea dolens, if throbolytic therapy does not dissolve clot

Question 20

what are some ways to treat chronic venous insufficiency?

Answer 20

vein ligation of incompetent perforator

valvular reconstruction or valve transplantation procedures infrequent

Question 21

what are four ways to treat varicose veins?

Answer 21

surgical
endovenous procedures
sclerotherapy
valvular reconstruction or valve transplantation (infreqe)

Question 22

what do the surgical procedure of varicose veins include?

Answer 22

saphenous vein removal or local excision (phlebectomy )of varicosities

Question 23

what are endovenous procedure of varicose veins treat?

Answer 23

treat the veins from the inside, using heart energy that causes the vein to shrink, then slowly disappear

Question 24

what are some major vein ablation?

Answer 24

radio freq ablation and laser ablation

Question 25

why would you scan a patient before/ after a vein ablation

Answer 25

confirm patency of veins, size and depth of vein to be treated, during procedure to follow catheter and post procedure to confirm vein ablation and absence of thrombosis

Question 26

what is sclerotherapy for treating varicose veins?

Answer 26

used to treat small varicosities by sealing them off; sclerosing agent, e.g sodium tetradecyl sulfate, injected into varix and compression dressing applied
can use saline

Question 27

what is TIPSS?

Answer 27

created to treat portal HTN

created betwen portal and hepatic veins (rt)

Question 28

what is the usual approach they use for a TIPSS insertion?

Answer 28

right IJV to IVC into right hepatic vein
bridge created to portal vein
tract stented with metallic endoprosthesis

Question 29

what will a stent look like on US?

Answer 29

echogenic