Venous Disease and Treatments
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What are 5 reasons for venous duplexing?
- 1.) R/O DVT
- 2.) Venous insufficiency
- 3.) vein mapping, CABG
- 4.) place stent
- 5.) suspect PE
How many cases of DVT a year?
How many cause of PE a year?
How many deaths from PE a year?
1-10 million cases of DVT a year
600,000 cases of PE a year
200,000 deaths from PE a year
What is superficial thrombophlebitis?
What does it involve?
inflammation of superficial veins and development of thrombus.
involves superficial veins only
- 1.) GSV
- 2.) SSV
- 3.) Cephalic V.
- 4.) Basilic V.
- 5.) Median Cubital V.
- 6.) Perforators
What are 3 main symptoms of superficial thrombophlebitis?
1.) Local erythemia (redness)
2.) Palpable subcutaneous cord
3.) very sore for patient
What should you do when scanning superficial thrombophlebitis?
Use a lot of gel and be fast
What are 4 treatments of superficial thrombophlebitis?
2.) Heat applications (helps heal and dissolve thrombus)
3.) Compression (so valves don't develop insufficiency)
4.) Non-steroidal anti-inflammatory drug therapy
What is a drug that is used for drug treatment of superficial thrombophlebitis?
Will they usually admit someone in the hospital for superficial thrombophlebitis?
What is called when someone gets a blood clot in the superficial veins?
What is the testing for superficial thrombophlebitis?
What are looked into when venous duplexing for superficial thrombophlebitis?
evaluate the extent or location of thrombus
make sure the thrombus does not extend into the deep vein system.
What are the 3 causes of DVT?
2.) Vein injury/trauma
What are examples of stasis - Causes of DVT?
- 1.) prolonged sitting
- 2.) during surgery
- 3.) Post-surgery
- 4.) trauma
- 5.) 3rd trimester of pregnancy
- 6.) acute paralysis
What are examples of vein injury/trauma?
- 1.) trauma
- 2.) HX of DVT
- 3.) Catheters in veins
What are examples of hypercoagulability?
- 1.) Antithrombin III
- 2.) Protein C
- 3.) Oral contraceptives
- 4.) Pregnancy
What are 7 risk factors for DVT?
- 1.) post-operative states
- 2.) previous DVT
- 3.) cancer-malignancy
- 4.) trauma
- 5.) oral contraceptive/hormone therapy
- 6.) immobility
- 7.) CHF
What are 5 symptoms of acute DVT?
- 1.) persistent calf pain, tenderness, feel achy
- 2.) calf or leg swelling
- 3.) PE
- 4.) Asymptomatic
- 5.) Fever
Sometimes what might be the only symptom of acute DVT?
What is the treatment and F/O of DVT? (2)
1.) anticoagulate for 6 weeks or more
2.) surveillance duplex ultrasonography for 7-10 days or longer
What is the most common site of thrombus in the calf?
Where are they draining into?
That then can drain into?
into the PTVs and Peroneal V.
Popliteal and femoral V.
What are the soleal sinuses?
holding chambers for blood deep in calf muscle
What is the treatment for thrombus in the soleal sinuses?
Controversial to treat
(Treat like superficial? OR Deep?)
What is the 3 possible treatment if DVT in femoropopliteal vein?
1.) Must have anticoagulations such as Warfrin, Lovanox.
2.) Started on Heparin and Coumadin
3.) Caval filter placement
Where is the most common location that Caval filter placement?
vena cava below the renal take off.
But can be placed anywhere above the POPV
What is the 2 symptoms of DVT in Fem-pop?
What is the preferred testing of DVT in Fem-pop?
- 1.) increase in calf pain
- 2.) swelling of calf
What are the symptoms of Iliac Vein DVT?
very similar to fem-pop thrombus
- 1.) increase in calf pain
- 2.) swelling of calf
What can help to image DVT in the iliac veins? (2)
- 1.) switch to lower frequency transducers
- 2.) use curved transducers
What is usually the first hint of iliac DVT?
Continuous flow = possible proximal obstruction
What is a rare testing for iliac DVT?
Why is it rare?
Venography- inject into vein in foot contrast.
Expensive, allergic reactions
What are 6 causes of DVT in Axillary-Subclavian?
- 1.) central venous lines
- 2.) TOS
- 3.) Trauma
- 4.) Surgery
- 5.) Radiation therapy
- 6.) Paget-Schroetter syndrome- Effort thrombosis
What type of cause of DVT causes another cause?
What are 3 symptoms of DVT in the axillary-subclavian?
1.) vague discomfort in arm
2.) marked arm swelling
3.) prominent superficial veins
What are two main goals for venous imaging to detect DVT?
1.) Determine presence or absence of DVT
2.) Risk of embolization
What most you do when doing a lower venous duplex? (3)
1.) put patient in 10-20 degrees or reverse trendelenberg position
2.) Use accompanying artery as a landmark for deep veins
3.) Compression of vein walls in transverse plane
What should be normal findings with venous duplex?
1.) anechoic within vein lumen- no echoes
2.) walls should compress with light probe pressure
What two things should you be careful when doing venous duplex scanning?
1.) Do not compress in sagittal view.
2.) Do not tilt too much will not be able to collapse veins.
What is one normal reason why a vein size should naturally increase?
vary with respirations (phasic flow)
What are 3 abnormal reasons that a vein size would increase?
increase in back pressure from:
2.) Proximal venous obstruction
3.) venous reflux
What are 5 main characteristics of Acute DVT?
- 1.) less than 14 days
- 2.) vein distention/DILATED
- 3.) loss of compressibility
- 4.) free floating thrombus
- 5.) low echogenicity even anechoic
What are 7 main characteristics of Subacute DVT?
- 1.) weeks
- 2.) reduce vein size
- 3.) thrombus now adhered
- 4.) decrease in thrombus size
- 5.) increase in echogenicity-brighter echoes
- 6.) recanalization-resumption of flow
What are 3 main characteristics of Chronic DVT?
- 1.) months to years
- 2.) echogenicity is greater or may blend in with the surrounding tissues
- 3.) valve abnormality
Can chronic DVT dissolve away naturally?
yes, a small % of patients will dissolve thrombus totally
What happens to thrombus that does not naturally lysed?
gets invaded by fibroblasts and becomes organized as fibrous tissue.
What are 6 imaging pitfalls of venous disease?
- 1.) suboptimal image
- 2.) obesity or pregnancy
- 3.) soft tissue edema, pitting edema
- 4.) compression difficulties
- 5.) duplication- Bi-fied system
- 6.) recurrent DVT
What are 7 non-vascular structures that can be found when venous imaging?
- 1.) Lymph nodes
- 2.) Baker's cysts in POPV area
- 3.) hematoma/abscess
- 4.) nerve
- 5.) bowel
- 6.) edema
- 7.) valves
What does IVCS stand for?
What is another name for it?
What is it?
Can cause what?
Iliac vein Compression Syndrome
compression of the left common iliac vein between the right common iliac artery and overlying vertebrae
causes intraluminal changes that could cause DVT
What is Candida Septic Thrombus?
Who gets it?
What does it look like?
fungal infection that enters the blood causing bloodstream infection.
low-birth weight babies, surgical patients, and those with weakened immune systems are more prone.
looks like blood clot, more round than thrombus
What would you like to do?
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