Venous Insufficiency and Current Treatments
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What are the four normal characteristics of veins?
What is the meaning of spontaneity?
picking up venous flow without help from maneuvers.
What is the normal spontaneity of veins?
veins should have spontaneity
If the tibial and peroneal veins do not have spontaneity can that be still be considered normal?
may or may not and still be normal
What is the meaning of phasicity?
venous flow varying with respiration
What are usually two abnormal characteristics of veins?
1. Continuous flow
What does continuous flow in a vein represent?
An proximal obstruction
What are three things that can cause continuous flow in veins?
1.) proximal obstruction
3.) 3rd trimester of pregnancy
What can you do if you are getting continuous flow in lower veins in a pregnant women?
Can roll patient onto side so continuous flow would stop. Baby may just looks like proximal compression.
What is the meaning of pulsatility?
response to cardiac cycle
Is pulsatility normal in the lower venous system?
What 2 things would it indicate?
- 1.) CHF (Rt. sided heart failure)
- 2.) Lt. sided heart failure
What are 3 things that can cause pulsatility in the upper extremity?
2.) Drinking copious amount of water
3.) Receiving a large amount of IV fluids or blood transfusion.
What does augmentation mean?
increase in venous flow due to maneuver
What should happen to flow when valsalva or a proximal compression?
If not its reflux
What are 2 reasons for venous insufficiency?
1.) valve malfunction
2.) venous occlusion
What are 3 things that can happen to the veins and the body when there is venous insufficiency?
1.) Fluid accumulation= edema
2.)Hemosiderin = hyperpigmentation = brownish color
3.) Venous ulcer
What are 5 characteristics of venous ulcers?
- 1.) not much pain
- 2.) red (rubor) in color
- 3.) tissue granulated
- 4.) wet and juicy
- 5.) like wet sandy texture
What are 7 possible treatments of insufficient superficial veins?
- 1.) Vein stripping
- 2.) Sclerotherapy
- 3.) New valves
- 4.) Compression stockings
- 5.) Una boot and medication
- 6.) RFA ablation
- 7.) ELVS ablation
What happens with sclerotherapy?
inject saline solution into the reticular (spider) veins
Wrap in bandage and put compression stockings on.
What is used to help heal venous ulcers?
Una boot and medication
What does RFA ablation stand for?
What does ELVS stand for?
Endovascular Lazer Venous System
What most be done before an patient has an ablation done? (7)
- 1.) Check for reflux on a tilt table.
- 2.) Check for DVT
- 3.) Find out how bad the reflux is = severity
- 4.) Measure vein size (diameter)
- 5.) Map the vein and any tributaries or perforators coming from the vein
- 6.) May need to find most optimal access point to enter the vein
- 7.) Note any aneurysmal areas or largest diameter size that is not throughout
What is the term used for branches of the main vein appearing to go above the layer of fascia?
What is the term used for branches of the main vein appearing to go below the layer of fascia?
Why is it important to measure the correct diameter of the vein to be ablated?
need to know the size of catheter to be used.
What must a sonographer do when a patient is on a tilt table?
What can help with this?
Check on patient. Patient can pass out.
Blood pooling in legs and repeatively doing valsalva stops blood flow from returning to hear.
Have patient take deep breaths and more feet/toes to help return blood.
What name of vein changes when it becomes varicosed?
What name does it change to?
Posterior thigh circumflex vein
What specific perforators become the most problematic?
Posterior tibial perforators
B/C in gaitor zone and increase in hydrostatic pressure.
What do perforators do?
connect superficial veins to deep veins
After an ablation of GSV, what should you check in the follow up? (3)
1.) make sure there is still flow within the superficial epigastric vein.
2.) check for DVT
3.) check if ablation was successful
How long most the reflux be to be considered:
Mild to Moderate =
Normal = < 0.5 seconds
Mild to Moderate = 0.5 to 1 second
Moderate = 1 to 2 seconds
Severe = > 2 seconds
What is another test that a sonographer could use to test for valve competence?
What be normal?
What would be abnormal?
- PPG testing
- Place PPG sensor above the medial malleolus 10 cm. Empty calf by heal toe raises.
- Never over varicosities
- Normal = >= 20 secs.
- Abnormal = < 20 seconds = valves not competent.
What is a test that can be done to test if reflux is in the superficial vs. the deep system?
Compress of the superficial system by inflating a cuff 20 mmHg or use an tourniquet.
What is a rare venous disorder when people are born with do deep veins below the iliac?
- 1.) congential
- 2.) can be totally absent or hypoplastic (they are there but non-functioning, underdeveloped.)
- 3.) Usually affects one limb
- 4.) May have birth marks- port wine stain
What rare venous disorder usually has a port-wine stain on one side of the forehead or eyelid?
What else? (1)
Arterial/ Venous malformations in cerebral vessels like an A-V fistulas.
What is the rare venous disorder when people have significant capillary hemangiomas?
Is it congenital?
What are the symptoms of Alba dolens Phlegmasias? (3)
- 1.) White leg (milk leg)
- 2.) painful
- 3.) swollen
Which Phlegmasia can also be called "milk leg"?
What can cause Alba dolens?
Arterial spasms that occur secondary to extensive acute iliofemoral vein thrombosis.
So clot pushes on arteries and causes them to spasm
What is the main explaination for Phlegmasias?
Blood can't get out because DVT occlusion
Blood can't get in because clots pushing on arteries.
What are the 3 main symptoms of Cerulea dolens?
1.) Bluish in color
What Phlegmasia causes the leg to be bluish?
What causes Cerulea dolens?
The arterial circulation is being compromised.
Usually caused by an acute iliofemoral vein thrombosis.
What is it called when there is slow sluggish flow which will eventually clot?
What is Ascending Venography used for?
How is it done?
Evaluate for DVT or congential abnormalitites or chronic venous obstruction
Inject contrast into dorsal vein in the foot.
What is Descending Venography used for?
Incompetency in venous valves
What are 4 limitations to venography?
- 1.) Expensive
- 2.) Invasive
- 3.) Allergic RXN possible
- 4.) Not good on kidneys
What can be used if patient can not take anticoagulants?
Vena Cava filters
What are three main anticoagulants?
Usually when is Heparin or Coumadin used instead of Lovenox?
when the clot is above the knee
Draw the venous spectral for lower extremity.
Increase in flow with expiration.
Decrease in flow with inhalation.
Draw the venous spectral for upper extremity.
Increase in flow with inspiration.
Decrease in flow with expiration.
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