Flashcards in Venous Deck (101):
What vessel on the arm is antero-lateral to surface of arm, what is this vein?
Characteristics at the medial and lower calf that caused an onset of ankle swelling:
Lack of spontaneous, phasic flow is normal in tibial veins
Ulcers caused by severe arterial/venous disease:
Arterial ulcers are Deep w/ regular shape, bony prominences, trophic changes. Least likely is brawny discoloration related to venous insufficiency
DVT, compression of left common iliac vein
A PT w/ swelling bilaterally in lower extremities, an acute DVT proximal to groin, where?
Inferior vena cava
Peripheral vascular occlusive disease(PVOD) in elderly PT with swollen extremity:
Check popliteal artery is deeper than popliteal vein
A duplex imaging exam finds a 9cm swelling and bluish discoloration in one leg compared to other leg:
Phlegmasia cerulea dolens(red), if leg is very pale would be phlegmasia alba dolens.
A hydrostatic pressure at the ankle of a 6 foot supine man would be?
What veins have the greatest number of valves?
Posterior tibial veins, venous valves increase distally(peroneal veins). More distal the vein in LE, the more valves it has
In an abdominal imaging in a PT w/ ascites , what is not a support for diagnosis of thrombi of the portal vein?
Hepato-petal flow is a normal finding
Lymph node images appear:
Brighter in center, surrounded by low level echoes
Lower left leg swelling, heaviness and varicosities in a 30 yr old mom, what is the cause most likely?
Chronic venous insufficiency
Least likely to occur w/ an effective calf muscle pump?
Increase in venous volume. Will have a decrease in venous volume/pressure and return blood to the heart, unidirectional flow from superficial to deep system, prevents reflux from happening
Femoral vein, used to be called superficial femoral vein:
Is not normally paired
A PT w/ a DVT, during exam what is least likely to cause a false positive study?
Presence of a bifed system
True about the GSV(great saphenous)vein:
Terminates at the saphenousfemoral junction, flow from posterior arch vein flows into GSV, GSV is longest vein in body
An approximate venous pressure at the ankle level is?
True of portal hypertension:
Elevated venous pressure is secondary to obstructive process, treatment usually require decompression of the portal venous system, related to some form of chronic liver disease, hepatitis-fugal flow may be evident in the portal vein, blood on portal vein is going away from liver cuz elevated venous pressure, elevated pressure can alter blood flow in portal vein going away from liver
Normal venous volume change inflow/outflow during air-plethysmorgraphic(APG) evaluation?
Venous system empties with passive leg evaluation
How does normal Doppler venous signal of arm differ from that of the leg?
Flow from the arm decreases during exhalation, while flow from the leg increases on exhalation
What effect does inspiration have on the lower extremity veins?
Inspiration causes venous outflow from the legs to be halted
During contraction of the calf muscles, venous pressure in the deep veins is greater than the pressure in superficial veins. What prevents blood from flowing into the superficial system from the deep?
Flow maintains its unidirectional flow because of the closed valves in the perforators
Veins are not completely passive structures, but have some reactivity referred to as venomotor tone, things that effect a venomotor:
Exercise, trams, deep breathing, temperature, light has no effect
In a duplex exam what is medial aspect of the lower calf? What can you see in transverse view represents which vessel is near fascia and fibula?
Posterior tibial artery and veins near fascia and peroneal artery and veins near fibula
True about an ineffective calf muscle pump?
Increase in volume/pressure is a result of ineffective muscle pump, incompetent valves cause reflux or venous pooling.. Possible increase in ambulatory venous pressure is secondary(venous hypertension)
What is the normal direction of blood flow in the perforating veins during muscle contraction?
The perforating veins always carry blood from superficial veins into deep veins, into deep from superficial
A PT w/ tender mass in R. Upper quadrant, in saggital view, the portal vein and hepatic artery are identified in the same plane, what colors would be displayed in this condition?
Both vessels will have same color, both carry blood to liver, should be the same color
What vessels form superior vena cava (SVC)?
SVC is formed by the confluence of the right and left innominate veins
A thrombectomy is usually reserved for limb threatening situation
Lyric therapy is usually reserved for limb threatening sit.
Edema, Fluid the subcutaneous tissue, what's related to this condition?
CHF, electrolyte imbalance, renal dysfunction
Normally, how does venous volume change with infow/outflow during an air-plethysmographic(APG) evaluation?
Venous system empties with passive leg evaluation
A PT had 9cm swelling and blush color on one leg, what will exam find?
Extensive, acute ilio -femoral deep venous thrombosis, phlegmasia cerulea dolens
True about the portal vein:
Hepato- petal(into liver), Portal vein formed by confluence of the superior mesenteric and splenic vein, flow in portal vein is little phasic, more continuous in nature, liver received blood from pancreas/gall bladder thru portal vein, not involved hepato-fugal= means flow away from liver
PPG detects peripheral arterial or venous systems, AC coupling (alternating current) for arterial exams and DC coupling (direct current) for venous studies.
DC detects slower flow changes than AC, electrical voltage is either positive or negative. Wall outlet not an example of DC. Wall outlet is alternating of 120 volts
What occurs w/ an effective calf muscle pump:
Venous return to heart increased w/ unidirectional flow is maintained from the superficial system into deep system. Bad pump increase in venous volume
In venous anatomy how are the veins in foramen most likely positioned from a lateral to medial orientation?
Cephalon, radial, basilic
Medial to lateral
Basilic, brachial, cephalic
An interruption device(filer) device normally placed?
IVC below renal veins
Blood in the basilic vein normally revels into what vessels?
A PT w/. Mass in upper R. Quadrant in an abdominal exam, in saggital view, the portal vein and hepatic artery are identified as the same:
Both have same color
Where does blood from the cephalic vein normally flow into?
CHF, hypotension and COPD disease can predispose a PT to which Virchow's triad?
A 26 yr old PT has 3 day pain, swelling, redness in R. Lower extremity, you are able to compress veins, flow pattern is accelerated rather than contra-laterally, what is this consistent w/?
Findings are suggestive of hyperemic flow associated w/ inflammatory process
A venous duplex exam order on a pt w/ 4 day pain and swelling in lower L extremity(calf area), what could this be?
Baker's cyst, lymphangitis, muscle tear, this is related to distal arteries. Thromboangiitis obliterans related to arteries not veins
What is the appropriate hydrostatic pressure(HP) at ankle level of a supine PT?
HP would be 0 mmHg
Venous flow is affected by respirations resulting in phasic signals, what effect does inspiration have on lower extremity veins?
Venous outflow from the legs is halted
A woman that's 32 weeks pregnant complaining of pain in left lower extremity, using continuos wave Doppler exam you can not obtain flow signal from left common femoral vein site, what can you do?
Reposition the PT in an extreme side-laying position and reevaluate. This try's to diminish extrinsic compression of IVC from pregnancy
The tibial veins
Do not normally have spontaneous/phasic flow
During a venous duplex exam, you document increases flow during the valsalva maneuver, what is this finding?
It is constant with venous reflux
A venous duplex exam finds an acute deep vein thrombosis of left common femoral vein w/ extension into the distal femoral vein( proximal obstruction) what following venous flow patterns would you see?
Left popliteal venous signal could lack spontaneous flow, venous signal of left popliteal will have diminished/absent augmentation w/distal compression, poor/absent phasic left popliteal venous flow
How are the veins positioned in the upper arm from medial to lateral?
Basilic, brachial, cephalic
An older PT w/ history of DVT is scanned to rule out an acute DVT pre-operatively, the PT asks how to prevent DVT?
Limit inactivity/bed rest, wear support hose, elevate legs and intermittent pneumatic calf compression during/after surgery. Heparin not needed to prevent DVT
What is most likely alteration in hemodynamics associated w/ an acute deep vein thrombosis(DVT)?
Decreases in pressure gradient between arteriole and venule
Why is there tourniquet used in venous studies utilizing photo plethysmography(PPG) & air-plethysmography(APG)?
Tourniquet eliminates the influence of the superficial venous system to differentiate superficial from deep venous system incompetence
An abdominal duplex exam ordered to evaluate a tender mass in upper right quadrant in Sagittal view, portal & hepatic vein identified on some plane, in normal conditions, what colors will be displayed in those vessels?
Both are the same coloration
Ulcers can be the result of many conditions, including severe arterial insufficiency. All are characteristics of arterial insufficiency:
Develop on bony prominences, deep w/ regular shape, trophic changes, dry skin, loss of hair and thickened toenails. brawny color not included
Usually the vein is able to accommodate large increases in volume without a significant increase in venous pressure, what is this term?
Anterior/posterior tibial veins, radial veins and brachial veins. Femoral veins not paired. Femoral vein previously called superficial femoral vein
A PT is in for an emergency venous duplex exam, what signs/symptoms is likely related to an acute deep venous thrombosis:
History of 4cm swelling, 3day leg pain, acute onset of swelling , pain & pallor/cyanosis. 4 day old of redness and warmth.
A PT w/ history of bilateral LE swelling, Doppler findings have good color filling, complete compressibility of vessel wall w/ spontaneous flow, pulsatile venous flow pattern that augments w/ distal compression, what could this be?
Findings suggest systematic venous hypertension, pulsatile venous signal secondary to venous hypertension, maybe associated w/ CHF or fluid overload.
Venous pressure in LE is affected by hydrostatic pressure, weight of column of blood above it, when standing, what factor is directly related to hydrostatic pressure(HP)?
Hydrostatic pressure is directly related to height of person
A 73 yr old admitted for acute onset of shortness of breath is being worked up for a pulmonary embolism(PE), what is the best test for this?
Most accurate test to document a PE is pulmonary angiogram
Normal direction of blood in the perforating veins:
Perforating veins carry blood from superficial into the deep veins towards heart
True about Superior vena cava(SVC):
Drains venous flow from head, neck and arms formed by confluence of the right and left innominate veins, blood from SVC drains into right atrium. SVC has no valves
What major differences between ascending and descending venography?
Ascending venography is primarily used to diagnose thrombus & contrast agent injected into the dorsum of foot
Trophic changes are related to?
Incompetence in what perforating veins/s most likely develops a venous stasis ulcer?
Perforators to the posterior arch vein
A PT w/ a DVT of left common femoral vein w/ extension into the distal femoral vein, what venous patterns would be expected of the left popliteal?
Poor/absent phasic flow of left popliteal, lack spontaneous flow, left popliteal have diminished/absent augmentation w/ distal compression. Won't see phasic flow
True about ineffective calf muscle pump?
Results of incompetent valves cause reflux, increase in venous pooling, an increase in venous volume & pressure
True about rouleau formation:
Vessel can coapt, flow can be phasic flow or heterogenous material, maybe normal in some PT's, augmentation w/ distal compression
Venous pressure in the LE affected by hydrostatic pressure, when standing, what factor directly related to hydrostatic pressure(HP)?
Hydrostatic pressure directly related to height of person
How does Doppler venous signal of the arm differ from legs?
Flow from arm deceased during exhalation, while flow from legs increases
What veins have the most valves?
A PT has history of large varicosities along the medial thigh w/ increasing discomfort, what study is best?
Ascending/descending venography, air-plethysmography, venous duplex exam, not a good exam for this is photoplethysmography
An upper venous study ordered the PT in the surgical ICU w/ a suspected acute superior vena cava syndrome, how would you expect venous return to the heart w/ inspiration?
Flow would stay the same, proximal compression will be continuos flow
What vessel does the internal jugular vein(IJV) carry blood to?
Left innominate vein, IJV joins the left subclavian vein
A pregnant woman has pain in LE, the tech cannot obtain a flow signal from L common femoral vein site, what needs to happen?
Reposition in an extreme side-lying position and reevaluate, this try's to diminish extrinsic compression on the IVC from pregnancy
A PT w/ history of bilateral lower extremity swelling, duplex shows good spontaneous color flow/filling compressibility of vessel wall, pulsatile venous flow that augments with distal compression, what's the explaination?
These findings suggest systematic venous hypertension, pulsatile venous signal is secondary venous hypertension maybe associated w/ CHF or fluid overload
Tech working on PT documents increased flow during the valsalva maneuver, what does this mean?
This is consistent with venous reflux, also during valsalva maneuver ,the color in the vessel goes from blue to red is venous reflex
A PT in ICU, duplex exam finds 9cm swelling and blush color of L lower leg compared to R leg, what do you expect to find?
Acute ilio-femoral deep vein thrombosis
Acute DVT has:
Very low level echos in a dilated vein, a PT has DVT with evidence brighter echos consistent w/ evidence of recanalization, flow in vein
A PT comes in w/ history of large varicosities in medial thigh and discomfort, what study does not look for incompetence, only obstruction?
What is the hemodynamics associated with acute DVT?
Decreases pressure gradient between arteriole and venule
A PT is having a upper venous duplex exam w/ a suspected acute superior vena cava syndrome, how would you expect the heart to be affected by inspiration?
Flow would be the same, proximal compression would result in continuos flow
A DVT is described by Virchow's triad from these factors:
MI, hormone replacement therapy and intravenous infusions
A PT has onset of SOB, chest pain, coughing up blood, what's the most accurate test for a PE?
Angiogram for PE
A younger PT has history of 4 day old pain and swelling in lower left extremity, possibility's are:
Lymphangitis, bakers cyst, muscle tear. Can't be thromboangitis obliterans, this is distal arteries not veins
Bright echos are more consistent with a chronic process
Low-level echoes more consistent with acute process
Normal direction of flow in the perforating veins?
Perforating veins carry blood from superficial into deep veins
Signs/symptoms are related to an acute DVT?
Acute pain, swelling, pallor, couple days of pain in lower extremities, redness and warmth.
Edema fluid in the subcutaneous tissue is related to these conditions:
Renal dysfunction, electrolyte imbalance, CHF and increased venous pressure
IJV, internal jugular vein carry blood to?
A PT being evaluated for a DVT, the right lower leg is swollen, know that:
In a bi-fed system, can cause a false negative exam, when actually is positive
Arterial ulcers have little to no bleeding and very painful, also arterial usually deeper w/ regular shape and often on bony prominences and has tropic changes.
Venous ulcers are shallow and irregular shape, ooze(bleed) and milder pain, often shallow near medial malleolus w/ brawny discoloration, can result in venous stasis dermatitis
Major difference between ascending/descending venography is?
Ascending is primary used to diagnose thrombus, contrast agent is injected into dorsum of foot
These precipitating factors of a DVT are described by virchow's triad?
Intravenous infusions, MI, hormone replacement therapy
What vessels form the tib-peroneal trunk?
Common peroneal and common posterior tibial veins
A PT is diagnosed w/ phlegmasia alba dolens of LLE, what treatment would be most recommended?
Procedures for a limb threatening situation:
Lytic therapy, femoral vein thrombectomy, anticoagulation, IVC filter
Tests for diagnosing a pulmonary embolism:
Venous duplex, ascending/descending venograms, a ventilation/perfusion (VQ) scan, angiogram is least accurate for PE