Lower Extremity Venous Anatomy and Hemodynamics Flow
Knowing that this runs alongside the vein in the lower extremity venous system, it helps to know the difference between say the posterior tibial vein and the lesser saphenous vein
What is an artery?
Called the "tail of the dog" sign, this is used to describe the following
What is acute DVT?
These veins are communicants between the superficial and deep system
What are perforators?
The basilic vein and cephalic vein are two examples of this type of vein
What is a superficial vein?
Vein diameters are important to note when assessing for bypass graft patency. In particular, a vein diameter measurement of this, is ideal!
What is 2.5mm or greater?
Lower extremity venous flow is aided in its return to the heart through such things like the calf muscle pump or the venous valves, but not by this
What is inspiration?
With this found within the great saphenous vein, it would be the most likely reason to perform surgery before it reaches the common femoral vein
What is a blood clot or superficial thrombophlebitis?
Flow color from blue to red, squeezing the limb proximally causing flow reversal on the spectral waveform, and crossing the baseline can all be observed when doing testing and are indicative of
What is valvular incompetency or venous reflux insufficiency?
You should be able to demonstrate these in the spectral waveform when imaging the subclavian vein
What are cardiac pulsatility and respiratory phasicity?
This vessel is best to used for a coronary artery bypass graft or CABG due to its similarity to the coronary artery in terms of size. However, it can't just be harvested unless there is a complete palmar arch involved!
What is the radial artery?
This vein is formed by the confluence of the peroneal veins and the tibial veins, and becomes the superficial femoral vein at the level of the adductor's canal
What is the popliteal vein?
If augmentation is performed in a DVT study distal to the transducer, this proves that complete obstruction by thrombus is not present
What is between the transducer and the point of augmentation?
These type of ulcers that may prompt an insufficiency study look irregular and shallow, the patient may have minimal pain, come with a brawny discoloration, and sometimes even ooze
What are venous ulcers?
From the confluence of these two veins, they form the superior vena cava
What are the right and left innominate veins?
Hmm, choices, choices! These other vessels are great alternatives to harvest for a bypass graft
What are the greater saphenous vein, the lesser saphenous vein, the ulnar artery, the cephalic vein and the basilic vein?
In understanding the hemodynamics of venous flow, when the intraluminal pressures rises...
What is transmural pressure rises?
This method is best when imaging the venous system to determine venous wall coaptibility
What is compression in the transverse plane?
Hang ten! Probably not the best thing to stay to your patient when you have them in this position for an insufficiency exam, but it is a great position to have them in for vasodilation. Let the gravity do the work!
What is reverse Trendelenburg?
Stop, drop, and roll! More than likely not one of the causes of DVT within the upper extremity, but it is good practice to keep in case you've caught on fire!
What is physical inactivity?
Although this test is not completely reliable, it still can be used to determine patency for harvest
What is the Allen Test?
These veins and muscles are what constitutes what is called "the little heart"
What are the gastrocnemius and soleus muscles and the gastrocnemius and soleal veins?
As a sonographer, when taking patient history, they may explain to you that they are not on any anticoagulation therapy, but that they have this device instead due to prior episodes of DVT
What is a venal caval interruption device or Greenfield filter?
In the use of photoplethysmography or PPG for venous testing purposes, a change in blood volume is detected by light
What is reflection?
Same-same, but totally different from the lower extremities, with inspiration, flow in the veins of the upper extremity
What is increase?
These vessels got their name because of how they disrupt the deep fascial plane
What are perforators?