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What is the most common reason why clinicians order a venous duplex sonography test?
evaluation for venous thromboembolic disease (VTE)
VTE refers to: (2)
1.) Deep venous thrombusis (DVT)
2.) Pulmonary Embolism (PE)
What is the annual incidence of VTE in the United States?
2.5 million cases
If a DVT is left untreated what could result?
Pulmonary embolism (PE)
Resistance to activated protein C is also known as:
Factor V Leiden
What is the standard for initial management of DVT?
Heparin given in IV
What is another management for DVT that takes longer to work?
How long does it take to work?
Usually 5 days
What is International Normalized Ratio?
A reflection of the inhibition of vitamin K-dependent cofactors.
What is the treatment for DVT that is not commonly used?
High risk of major bleeding
How long should a person be on an anticoagulant?
3 months with uncomplicated DVT maybe longer.
Sometimes a lifetime.
Where do lower extremity DVTs become established?
Deep veins in the calf
What is the treatment for patients that can't take anticoagulants?
Caval filter placement or caval interruption is necessary
Why has axillosubclavian DVT become increasingly common?
Increase use of central venous catheters.
What are the symptoms of axillosubclavian venous thrombosis?
Arm swelling and pain
Adequate restoration of flow to the central circulation.
Vein wall and valves are permently damaged in what percentage of cases from DVT?
What are the results that occur with vein wall and valve damage?
Incompetence and reflux, venous hypertension
What is the gaiter zone?
Lower calf and ankle
What is the main visual hint of Phlegmasia Cerulea Dolens? (2)
Severe cyanosis (bluish color)
the leg will be 3 to 4 times bigger
What is the main visual hint of Phlegmasia Alba Dolens?
Whitish "milk leg"
What form of DVT is bluish color and is caused by the arterial circulation is minimized caused by the DVT?
Phlegmasia Cerulea Dolens
What form of DVT is whitish color and is caused by an inflammation of femoral vein?
Phlegmasia Alba Dolens
What form of DVT is sometimes seen after childbirth or after a severe febrile illness?
Phlegmasia Alba Dolens
What are four reason to perform venous testing?
- 1.) R/O DVT
- 2.) venous insufficiency
- 3.) Pulmonary Embolism
- 4.) Vein mapping
Where are three areas that thrombus normally starts in the lower extremities?
- 1.) Soleal Sinueses (Drain into peroneals or post tibs.)
- 2.) Valve sites
- 3.) Lt. common Iliac V.
What are 12 risk factors that may warrant venous testing?
- 1.) Immobilization (long periods of bed rest)
- 2.) Surgery within 3 months
- 3.) Trauma
- 4.) Stroke, paralysis of extremities
- 5.) History of VTE or DVT
- 6.) Malignancy (cancer- alters blood chemisty)
- 7.) Obesity (weight pushes on Common Iliac A.)
- 8.) Cigarette smoking
- 9.) Oral contraception, hormone replacement therapy.
- 10.) Pregnancy and puerperium (6 wks after birth)
- 11.) Congestive heart failure (CHF)
- 12.) Sickle cell anemia (genetic- African American)
What are the three main signs and symptoms of DVT?
- 1.) Acute calf pain associated with localized tenderness, heat and swelling.
- 2.) Superficial veins may be dilated b/c deep veins are blocked so blood backs up.
- 3.) Significant swelling of the thigh if thrombus in proximal veins.
What is the + Homans sign?
Dorsal flexion of foot and gives pain in calf.
What is Superficial Thrombophlebitis?
- - Inflammation of superficial vein with thrombus formation.
- - Symptoms:
- 1.) Redness and warmth
- 2.) Severe pain
- 3.) You can feel a palpable cord
What is Venous Insufficiency?
- Valves are not working properly to prevent backflow.
- Caused by: DVT thrombus it damages the valves.
What are the Chronic venous insufficiency symptoms? (4)
- 1.) Hyperpigmentation (rusty color in gaiter zone)
- 2.) Ulceration
- 3.) Edema
- 4.)Dilated protuberant varicose veins
What does Primary varicose veins affect?
What are three causes of primary varicose veins?
Involves the superficial system only.
- 1.) Pregnancy
- 2.) Obesity
- 3.) Hereditary Factors
What does Secondary varicose veins affect?
Both Deep and superficial venous systems.
- Caused by:
- An obstruction or incompetence of the deep venous system.
What are three factors that contribute to thrombus formation?
- 1.) intimal injury
- 2.) stasis
- 3.) hypercoagulability
How does intimal injury cause thrombus formation?
damaged intimal sends out signal for clot formation.
What are some things that may cause intimal injury? (3)
- 1.) needle sticks
- 2.) blunt trauma
- 3.) IVs being left in for longer period of time
What does stasis mean?
blood standing still or slowing down, increase clotting.
What are some things that cause stasis? (11)
- 1.) any prolonged sitting (car rides)
- 2.) patient on bed rest
- 3.) 3rd trimester of pregnancy
- 4.) acute paralysis
- 5.) surgical patients
- 6.) trauma patients
- 7.) obesity
- 8.) obesity
- 9.) CHF
- 10.) Acute CVA
- 11.) Hx of DVT
What things cause Hypercoagulability? (
- 1.) Pregnancy
- 2.) Cancer
- 3.) birth control pills
- 4.) liver disease
- 5.) smoking
- 6.) protein C or S deficiency
- 7.) antithrombin 3 deficiency
What is primary lymphedema? (2)
when the lymphatic system is hypoplastic (small) usually due to a congenital abnormality or no lymphatic system at all.
usually seen in the young
What is secondary lymphedema?
caused by infection or trauma to the lymphatic system.
What is Kleppel Trenauney Syndrome?
Is a congenital condition and consists of a triad of abnormalities.
Only affects one limb.
What are some symptoms of Kleppel Trenauney syndrome? (5)
- 1.) port-wine stain birthmarks
- 2.) can have minor to severe varicose veins
- 3.) absence of deep veins
- 4.) small deep veins
- 5.) large dilated deep veins with non-functioning valves
What is Sturge-Weber?
Hypoplastic (small vessels) with AVMs in cerebral vessels.
What does hypoplastic mean?
What does AVMs mean?
What is Kasabach-Merritt?
a congenital affect that includes capillary hemangiomas.
What is Venography?
A rare procedure in which contrast agent is injected into the venous system through the dorsal foot vein.
Checks for DVT.
What is Ambulatory venous hypertension?
The persons venous pressure does not go down when walking.
What is the symptoms of ambulatory venous hypertension?
edema (can have pitting edema) that starts at the feet and ankles and goes up.
What is cellulitis?
tissue break down
What is hyperpigmentation?
due to increased pressure within the tissue which causes the RBCs to become trapped outside of the cell in the tissues.
What is Induration?
damage increase causes tissue to harden
Which type of ulcer is easier to heal?
arterial ulcers are easier to heal than venous ulcers.
As soon as you resupply blood to area begins to heal.
Name 4 Perforator veins.
- 1.) Dodd's
- 2.) Boyd
- 3.) Cockett's
- 4.) Giacomini
What is the new name for Dodd's Perforator?
Femoral canal perforators
What is the new name for Boyd perforator?
What is the new name for the Cockett's Perforator?
Posterior Tibial Perforator
True or False.
Perforator veins are usually pretty deep.
- Perforator veins are usually pretty superficial.
How many perforator veins can be in each leg?
Out of how many of those can be clinically significant?
90-150 per leg
only 3-5 are clinically significant
If a patient has had an ablation of the GSV what are three things you need to check?
- 1.) Need to make sure no thrombus going into the deep system.
- 2.) Make sure GSV is really ablated.
- 3.) Make sure flow in the EPI vein. (Superficial Epigastric vein).
What does EPI vein stand for?
Superficial Epigastric vein
what does the EPI vein drain?
the pelvis region.