Final Review Flashcards
(69 cards)
1
Q
Deep Veins
A
- Carry majority of leg blood volume
- run alongside major arteries of the same name
- become paired in calf
2
Q
Superficial Veins
A
- smaller in diameter
- close to skin surface
- have no accompanying arteries
3
Q
Perforating Veins
A
- allow communication between deep and superficial veins
- normal flow: superficial to deep
- pass through the deep fascial plane
- have valves to prevent flow from moving deep to superficial
- not typically seen
4
Q
Calf Muscle Veins
A
- considered part of the deep system
- drain blood from gastrocnemius and soleus muscles in calf
5
Q
IVC : inferior vena cava
A
connects common iliac veins to right arm
6
Q
CIV: common iliac vein
A
formed by union of internal and external iliac veins
7
Q
EIV : external iliac vein
A
extends to the inguinal ligament
8
Q
IIV: internal iliac vein
A
drains blood from pelvis, aka hypogastric vein
9
Q
CFV : common femoral vein
A
extends from inguinal ligament to bifurcation
10
Q
GSV: greater saphenous vein
A
arises from medial aspect of CFV at saphenofemoral junction (SFJ)
aka long saphenous vein
runs medial leg groin to foot
~30% duplicated or non continuous
11
Q
Femoral Vein (FV P, M, D)
A
begins at bifurcation passes through adductor canal at distal
aka superficial femoral vein
12
Q
PFV: deep femoral vein
A
joins femoral vein to form CFV
drains thigh and lower pelvis
aka profundal vein or profundal femoris vein
13
Q
POP V: popliteal vein
A
runs behind knee
connects anterior tibial vein/tibioperoneal trunk to femoral vein
14
Q
SSV: small saphenous vein
A
arises from popliteal
passes inferiorly along calf
aka short saphenous vein or lesser saphenous vein
- runs posterior calf
- 20-30% of people will enter above the POP V
15
Q
Gastrocnemius Veins
A
Drains gastrocnemius muscle
empties into popliteal vein
paired veins
16
Q
Soleal Veins
A
drain soleus muscle
empty into PTVs and peroneal veins
17
Q
AVTs : anterior tibial veins
A
drain anterior calf and foot
paired veins
18
Q
PER Vs: peroneal veins
A
drain medial and posterior calf
paired veins
19
Q
Bifid Femoral Vein
A
- may occur in prox, mid, or distal FV
- may continue through POP V or may rejoin dominant vein
- duplication noted in ~30% of population
20
Q
Venous Hemodynamics
A
- veins are highly compliant (expand/collapse)
- shape varies with changes in transmural pressure
- high pressure: round
- low pressure: “dumbbell” shape
- being able to expand allows veins to hold more blood without affecting the pressure gradient
21
Q
Capillary Pressure Gradient
A
- flow across capillary bed governed by pressure gradient
- higher pressure in arterioles due to cardiac contraction
- lower pressure in venules due to compliant nature
22
Q
Distal Venous Pressures
- standing ?
- lying?
- walking?
A
- standing : 80 mmHg
- lying : 10 mmHg
- walking : 25 mmHg
23
Q
Hydrostatic Pressure Effect
A
- increased transmural venous pressure distally
- increased venous distention
- increased venous pooling
- decreased in capillary perfusion
- decreased in venous return
- decreased in cardiac output
24
Q
Inspiration
A
- diaphragm moves downward
- intraabdominal pressure increase
- IVC is compressed
- venous outflow is temporarily reduced or stopper
25
Exhalation
- intraabdominal pressure decreases
| - flow resumes
26
Flow Patterns in LE Veins
- normally phasic and spontaneous ( NOT pulsatile)
- cardiac influence is usually not apparent or is reduced in LEV
- increased resistance due to congestive heart failure causes pulsatility
27
Impediments to LEV flow
- hydrostatic pressure
- flowing against gravity
- increased transmural pressure
- dissipation of cardiac contraction across capillary bed
28
How do we get blood back to the heart?
three pumps in the leg:
- foot pump: primes the calf pump
- calf veno motor pump: major ejection
- thigh pump: ejects thigh blood volume
29
Venous Valve Distribution
```
IVC 0
CIV 0
EIV 0
FV: 4
GSV: 12
POP V: 2
PTV: 10
PER: 10
ATV: 10
```
30
What is the calf veno-motor pump is made of what?
veins in calf
skeletal muscles
semilunar valves
31
Calf Muscle Contraction
1. blood volume in deep calf veins and soleal sinuses is squeezed up and out of calf
2. proximal valves of deep veins are forced open
3. distal valves of deep veins are forced open
4. perforator valves close to prevent flow into superficial system
32
Calf Muscle Relaxation
1. proximal valves close due to the hydrostatic pressure forcing blood back down the veins to the level of the valve
2. distal and perforator valves open, and blood flows into the calf deep veins
33
Calf Veno-Motor Pump
- facilitates venous return to heart
- reduces the effect of hydrostatic pressure
- reduces distal intraluminal pressure
- reduces venous pooling
34
Efficiency of Calf Veno-Motor Pump is depended on what
1. the ability of calf skeletal muscles to contract
2. the competency of the venous valves
3. the patency of outflow veins
35
Venous Duplex Techniques
1. compressibility of veins
2. visualization of thrombus/lumen
3. filling with color doppler
4. analysis of spectral doppler
36
Venous Thromboembolism
- covers venous thrombosis (superficial or deep)
- more than 500,000 cases of DTV each yr in US
- 200,000 fatal cases of PE annually
37
Virchows Triad
stasis
hypercoagulability
vein wall injury
38
Risk Factors for DVT
- surgery or trauma
- immobilization
- previous DVT
- cancer
- pregnancy
- coagulation disorders/thrombophilia
- estrogen therapy / birth control pills
- "economy class syndrome" / long distance travel
39
Symptoms of DVT
- persistent acute onset leg pain
- unilateral leg swelling (edema)
- calf pain/tenderness (especially with dorsiflexion)
- erythema and warmth of extremity
- symptoms of venous insufficiency with chronic DVT
40
D Dimer Test
- elevated with DVT/PE as well as liver disease, trauma, pregnancy (false positives)
- if below threshold can be used to predict absence of thrombus
41
Phlegmasia Cerulean Disease
- symptom with highest PPV for DVT
| - iliofemoral outflow obstruction presents as massive thigh/calf swilling and limb cyanosis
42
Symptoms of Superficial Thrombophlebitis
- erythema/inflammation
- local tenderness
- palpable cord or mass
- usually more painful than DVT
43
Criteria for Venous Thrombosis
- absence of vein compressibility
- visualization of thrombus
- vein distension
- abnormal doppler signals
- reduced/absent augmentation
- reduced/absent color filling
44
Acute DVT
- weakly echogenic or partially anechoic thrombus
- poorly attached thrombus "finger"
- spongy texture
- dilated vein
45
Chronic DVT
- highly echogenic thrombus
- well attached thrombus
- rigid/fibrous texture
- veins smaller than arteries
- presence of collaterals
- recanalization and/or venous webbing
46
May Thurner Syndrome
- thrombosis of left iliac vein
| - occurs due to compression by overlying right iliac artery
47
Differenital Diagnoses for Leg Pain and Swelling
- bakers cyst
- popliteal artery aneurysm
- muscle tear
- hematoma
- lymphedema
- cellulitus
48
Baker's Cyst
- synovial lining and fluid bulge into the popliteal space
- may rupture or dissect into calf muscles or along intermuscular symptoms
- demonstrate communication with joint space
49
Calf Hematoma
- contains low level echoes
- occurs anywhere around muscles
- absence of joint space communication
50
Lymphedema
- "ant farm" appearance to tissues
- may compress calf veins
- can limit augmentation
51
Intimal Injury
- IV or central line
- pacemaker wire
- stents
- IV drug abuse
- fibrosis from radiation therapy
52
Stasis
- compression by mass
| - thoracic outlet compression
53
Hypercoagulability
- thrombophilia
- cancer
- estrogen therapy
- pregnancy
54
UEV Deep Veins
```
SVC
innominate
subclavian
axillary
brachial
radial
ulnar
```
55
UEV Superficial Veins
basilic
cephalic
median cubital
56
Normal Upper Venous Flow
- should still see respiratory phasicity
| - more central veins have extensive influence from cardiac pulsatility
57
Arm Vein Assessment
- for more central (prox) veins: emphasis is placed on color/waveform analysis
- for more peripheral veins (arm and forearm): compression method is primary diagnostic method
58
Indications for Forearm Veins
- local, palpable cord; suspicion of superficial thrombophlebitis
- infusion difficulty with peripherally inserted central catheters (PICC lines)
- preop assessment for hemodialysis access placement (scan superficial veins only)
- preop for vein harvest for arterial bypass (determine patency and size)
59
Criteria for UE Venous Thrombosis
- visualization of thrombus
- lack of vein coaptation
- no flow: color and spectral doppler
- abnormal flow patterns and flow direction in central veins
60
Paget-Schroetter Syndrome
- spontaneous thrombosis of subclavian or axillary
- effort induced
- repeated extrinsic compression
- extensive collateral development in the presence of SCV compression can be precursor
- infraclavicular, transverse view looks like swiss cheese
61
Super Vena Cava Syndrome
- occlusion or compression of SVC
- increased venous pressure
- edema of neck, face, and arms (usually bilaterally)
62
Venous Insufficiency/ Venous Incompetence
| primary and secondary
- primary: congenital absence or malfunction of valves
| - secondary: post phlebotic damage to valves secondary to thrombosis and/or venous outflow obstruction
63
Symptoms of Venous Insufficiency
- recurrent calf, ankle, or foot swelling
- varicosities
- venous claudication
- stasis dermatitis
- ulceration
- chronic limb swelling
64
Abnormal Reflux Times in standing patients
- deep veins > 1.0 seconds
- GSV, SSV > 0.5 seconds
- Perforating Veins > 0.35 seconds
- longer duration in supine patients
65
Tunica Intima
- inner most layer
- single cell layer in contact with blood
Provides:
- permeability
- antithrombogenic properties
- vasoreactivity
66
Tunica Media
- middle layer
- composed of smooth muscle cells
- allows rhythmic changes in the arterial size with cardiac cycle
- surrounded by elastic membrane
67
Tunica Adventitia
- outer layer
- contains connective tissue and collagen
- contains the vaso vasorum: tiny blood vessels that supply the artery wall
68
Blood flow in the extremities is controlled by what
- cardiac output
- intraluminal wall resistance
- arterial wall compliance
- dynamics of arteriolar vasoconstriction and vasodilation in the distal vascular beds
69
Normal Peripheral Arterial Waveform
1. in systole, intra-arterial pressure is high, flow moves forward
2. in early diastole intra-arterial pressure is decreased and pressure distally is high; pressure gradient (and flow) reverses
3. arterial wall compliance (rebounding) resumes forward flow
