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Vascular Sonography > Venous Ch 24-33 > Flashcards

Venous Ch 24-33 Flashcards

1
Q

Difference between the pressure within the vein (intramluminal pressure) and from outside the veins (interstitial pressure)

A

transmural pressure

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2
Q

the venous system holds _____ of total blood volume

A

two-thirds

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3
Q

veins can distend ____ times that of the coresponding artery.

A

3-4

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4
Q

The greater resistance occurs when the vein is ________ and the least resistance exists when the vein is _________

A

elliptical, distended

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5
Q 
supine = \_\_\_\_\_ transmural pressure 
Standing = \_\_\_\_\_ transmural pressure
A

low

high

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6
Q

is caused by the weight of a column of blood extended from the heart to the level where the pressure is being measured

A

hydrostatic pressure

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7
Q

hydrostatic pressure = _ x _x _

A

p,g,h
p= blood density (specific gravity of blood)
g= acceleration due to gravity
h= height of the column of blood (distance from the heart)

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8
Q

hp at the ankles

A

100mmHg (ankle P = circulatory + 100mg)

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9
Q

arm pressure =

A

venous P - 50mmHg

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10
Q

during inspiration…

A
  • pressure decreases in chest
  • increased abdominal pressure
  • IVC collapses and venous return from the legs is impeded
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11
Q

during expiration…

A
  • abdominal pressure decreases
  • pressure increases in chest
  • flow increases from legs into abdomen
  • blood flow is decreased into the thorax
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12
Q

valsalva maneuver causes the intrathoracic and intraabdominal pressure to ….

A

increase significantly
all venous return is halted
the maneuver equates with proximal compression while preforming doppler assessment of the lower extremities

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13
Q

Normal time when testing for venous reflux*

A

Normal 1 sec

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14
Q

In the past, the clinical diagnosis of acute DVT based on pt medical history and physical exam was considered _________ (___%)

A

very unreliable, less than or equal to 50%

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15
Q

most common clinical findings of ACUTE DVT

A
  • swelling
  • pain
  • redness, or erythema
  • warmth
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16
Q

nonspecific test for deep venous disease since any inflammation of muscle will elicit the same result

A

Homan’s sign

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17
Q

symptoms of CHRONIC DVT…

A
  • swelling
  • erythema
  • heaviness/aching
  • discoloration or ulcerations
  • varicosities
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18
Q

CEAP is the international standard for describing clinical manifestations and pathologic features of chronic venous disease

A 
C = Clinical disease
E= Etiology
A= Anatomic distribution of reflux
P= underlying Pathology
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19
Q

the development of venous thrombosis is based on three factors know as __________

A

VIRCHOW’S TRIAD***

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20
Q

what are the three factors in Virchow’s Triad?***

A
  • trauma to the vessel
  • venous stasis
  • hypercoagulability
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21
Q

thrombosis usually occurs at the most _______ portion of the PICC line

A

proximal

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22
Q

what can cause venous stasis?

A
  • bed rest or immobility
  • CHF
  • obesity
  • COPD
  • pregnancy
  • previous DVT
  • extrinsic compression
  • surgery-associated condition
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23
Q

what can cause hypercoagulability?

A
  • cigarette smoking
  • brith control pills
  • estrogen intake
  • cancer
  • pregnancy
  • inherited states, e.g. factor V leiden etc.
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24
Q

also known as stress or effort thrombosis
-usually involves thrombosis of the subclavian or axillary vein secondary to intense, repetitive activity
-venous component of TOS
Ex. heavy lifting or strenuous throwing of base ball or football

A

Paget-Schroetter Syndrome***

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25
Q

left common iliac vein compression by the right common iliac artery as the artery crosses over it.

A

May-Thurner Syndrome***

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26
Q

what is Nutcracker syndrome?

A

compression of the left renal vein between the aorta and the SMA

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27
Q

hypoplatic or complete absence of the deep veins (absent iliacs with varicosities of the superfical system resulting in a enlarged limb

A

Klippel-Trenaunay

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28
Q

in klippel-Trenaunay severe varicose veins, widely dispersed, are commonly seen on the _______ aspect of the thigh and calf.

A

lateral

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29
Q

causes of portal hypertension

A
  • chronic liver disease such as cirrhosis
  • severe CHF
  • proximal venous occlusion
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30
Q

most common symptom of Superior Vena Cava Syndrome

A
  • dysonea (difficulty breathing) is most common

- facial and extremity swelling may also be evident

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31
Q

most common solid renal mass in adults that can result in thrombosis of the renal vein.

A

Renal Cell Carcinoma

32
Q

most common cause of IVC tumor

A

Renal Cell Carcinoma

33
Q

secondary varicose veins are a result of …

A

constructive conditions

value damage from DVT, pregnancy, obesity

34
Q

thickening or hardening of the skin and can be found in pt with chronic venous insufficiency

A

lipodermatosclerosis

35
Q

What is “bottle-neck-deficiency” ?

A

over time tissue becomes depressed, changing the contour of the ankle area

36
Q

limb threatening condition that results from arterial spasms that occur secondary to extensive, acute ilio-femoral vein thrombosis; Limb is very swollen, pale, and painful
whiteness (pallor)

A

phegmasia alba dolens

37
Q

complications of an acure iliofemoral vein thrombosis severely reduced venous outflow causes marked reduction in arterial inflow
tissue hypoxia can develop, leading to venous gangrene
limb is very swollen, dark blue, and painful
limb threatening!

A

plegmasia cerulea dolens

38
Q

1st stage- phegmasia alba dolens and
2nd stage- plegmasia cerula dolens
are both examples of an ______

A

acute DVT

39
Q

the formation of local defects on the surface of skin that occurs with the sloughing of inflammatory necrotic tissue - can be associated with venous disease

A

ulceration

40
Q

where do venous ulcers usually occur?

A

around the medial malleolus where the posterior tibial (formerly Cockett’s I, II, and III) perforators are located

41
Q

one of the most consistent signs of elevated venous pressure

A

edema

42
Q

documents capillary blood volume, evaluates the presence and severity of venous insufficiency
(microcirculation)

A

PPG

43
Q

how is the pt positioned for a PPG?

A

seated with legs dangling, i.e. nonweight bearing

sensor is placed on the lower leg, 5-10cm above the medial mallelous

44
Q

speed of the strip chart recorder for PPGs

A

5mm/sec

45
Q

technique used for PPGs

A
  • pt is instructed to dorsiflex the foot 5 times to empty veins
  • tracing is recorded after dorsiflexions to record venous refill time or venous reactive time (VRT)
46
Q

normal venous reactive time…

A

greater than or equal to 20 sec***

47
Q

If VRT is less than ______ sec the study is repeated with a tourniquet test to determine if the incompetence is coming from the superficial or deep system

A

20

48
Q

VRT of less than 20 sec without the tourniquet that normalizes to greater than 20 sec with the touriquet ABOVE THE KNEE is consistant with reflux in the ….

A

great saphenous

49
Q

VRT of less than 20 sec without the torniquet that normalizes to greater than 20 sec only when the tourniquet is applied BELOW THE KNEE is consistant with reflux in the …..

A

small saphenous

50
Q

a VRT of less than 20 sec with and without tourniquet application is consistent with….

A

reflux in the deep system

51
Q

Normal VFT is _____, minor to moderate reflux is _____, and severe reflux is _____

A

less than or equal to 2, greater than 2-10, greater than 10

52
Q

normally want the ejection fraction a high percentage, Normally the calf expels _____ with one toe up

A

greater than 60%

53
Q

a residual volume fraction of _____ is considered normal

A

less than 35%

54
Q

reverese trendelenbury is approx. ____ degrees

A

30

55
Q

continuous wave doppler ___MHz at _____ degrees

A

5, 45-60

56
Q

continuous wave interpretation

A

-spontaniety, patency, respiration/phasicity

57
Q

continuous flow patterns of veins of the upper or lower extremity are usually consistent with ______ venous obstruction

A

proximal

58
Q

most common duplications

A

-femoral and popliteal vein

59
Q

when identifying venous insufficiency a _____cm cuff is is applied to the high thigh portion of the leg
the cuff is then inflated to ____mmHg and maintained for ____ seconds

A

12x40
80
1-2

60
Q

the cuff is inflated to ____mmHg for the popliteal vein and placed on the calf

A

100

61
Q

for the posterior tibial vein the cuff is inflated to _____mmHg

A

120

62
Q

how can you optimize the system for low velocity flow detection

A
  • decrease scale
  • decrease wall filter
  • increase color gain
63
Q
  • largest vein in the upper arm

- medial and superficially without an companion artery

A

basilic vein

64
Q

if a perforator vein has a diameter of ____mm, many think its probably normal regardless of flow direction

A

less than 3

65
Q

if a pt has a dialysis accsess graft what should be expected

A
  • increased velocity and volume flow
  • pulsatile flow
  • no response to distal compression
  • incompressible vessel
  • collateral channels evident
66
Q

sluggish flow seen as heterogenous material moving with respirations and augmentation maneuvers
-red blood cells arrange like a roll of coins or roleau

A

roleau formation

67
Q

a compressible vessel with evidence of roleau formation on b-mode suggest ______ obstruction

A

proximal

68
Q

if the perforator measures greater than 3,5mm reflux has been found to be present about ____ of the time

A

90%

69
Q

two alternative diagnostic tests related to venous diseases

A
  • D-dimer

- contrast venography (used to evaluate pulmonary embolism)

70
Q

proteins produces when a blot clot dissolves in the body and normally is undetectable in the blood.

A

D-dimer

71
Q

considered the “gold standard”

the number has decreased due to the accuracy of duplex scanning

A

contrast venography

72
Q

the most common cause of varicose veins is imcompentence of the _______ vein

A

great saphenous

73
Q

used to treat small varicosities such as spider veins

A

sclerotherapy

74
Q

primary treatment of non healing ulcers

A

unna boots

75
Q
  • fistula in the non dominate arm

- radial artery to cephalic vein fistula is most common

A

Brescia-Cimino Fistula

76
Q

grafts are usually made of _____ commercially known as _____

A

teflon , Gore Tex

77
Q

requirments for AVF and grafts

A
  • venous diameter is greater than or equal to 2.5mm
  • for a graft the vein should be greater than or equal to 4mm
  • within 1cm of the skin surface

Vascular Sonography (8 decks)

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