Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
98 Cards in this Set
- Front
- Back
What do the Digital Veins make up?
|
Metatarsal Veins
|
|
What do the Metatarsal Veins make up?
|
Deep venous arches
|
|
May-Thurner Syndrome
|
The left CIV passes beneath the right CIA to empty into the IVC. This pressure point is recognized by some to account for the increased incidence of left lower extremity DVT.
|
|
Where is the confluence of the CIV to form the IVC?
|
Level of the 5th lumbar
|
|
What vessels form the GSV?
|
Digital Veins
|
|
Each perforator has at least ____ valves to maintain unidirectional flow.
|
1
|
|
What is the branch of the GSV below the knee?
|
Posterior Arch Vein
|
|
Where are the 3 Cockett Perforators located?
|
3 ankle perforating veins
Importance with venous stasis ulcers. |
|
Where is Boyd's Perforator?
|
At the Knee
|
|
Where is Dodd's Perforator?
|
Distal thigh
|
|
Where is the Hunter's Perforator?
|
Mid Thigh
|
|
What are the venous sinuses of the legs?
|
Soleal & Gastrocnemius veins.
|
|
Which veins form the Palmar Arches?
|
Deep Digital Veins
|
|
Portal Vein
|
Formed by the Superior Mesenteric and Splenic Veins, carry blood into the sinusoids of the liver. Portal Vein is the predominant source of blood flow into the liver (80%).
|
|
What is Flow into the liver?
|
Hepatopetal
|
|
Where does the Hepatic Vein carry blood from?
|
Carries blood from the liver into the IVC
|
|
What is Flow away from the liver called?
|
Hepatofugal
|
|
Veins expand in response to what?
|
Transmural Pressure aka Distention Pressure
|
|
Venomotor Tone
|
Veins element of reactivity when smooth muscle cells contract with temp, exercise, stress and trauma
|
|
What is the Tunica Intima made up of?
|
Single layer of endothelial cells
|
|
What is the Tunica Media made up of?
|
Thicker layer of smooth muscles and collagenous fiber
|
|
What is the Tunica Adventitia made up of?
|
Fibrous layer surrounding elastic tissue. Contains the Vasa Vasorum
|
|
What kind of valves are in the venous system?
|
Bicuspid Valves
|
|
Which veins have valves?
|
GSV, SSV, Perforators, Infrapop, Pop, Fem, EIV (25%), CFV, IJV, Ax, Cephalic and Basilic
|
|
Which veins do not have valves?
|
Soleal, EIV (75%), IIV, CIV, IVC, SubcV, Innominate Veins, and SVC
|
|
Are veins compliant or not?
|
Highly compliant
As intraluminal pressure increases the veins expands As intraluminal pressure decreases - "dumbbell" |
|
Transmural Pressure
|
The differences between pressures within (intraluminal) and outside (interstitial) of the veins.
The higher the intraluminal pressure the higher the Transmural Pressure. |
|
Due to the flattened shape of veins most of the time, are veins high or low resistance?
|
Low Resistance
|
|
Hydrostatic Pressure
|
Equivalent to the weight of a column of blood extending from the heart to the level being measured.
Supine - 0mmHg Standing at ankle - 100mmHg Standing, above heart - pressure decreases |
|
What are the calf muscles also known as
|
"Venous Heart"
|
|
Where does blood flow during muscle contraction and relaxation?
|
Contraction: Deep system toward the heart
Relaxation: Superficial into Deep via perforators |
|
What happens during Inspiration?
|
Increase in intraabdominal pressure, decrease in intrathoracic pressure
Increases blood flow from arm and head veins Decreases blood outflow from peripheral veins and lower extremity |
|
What happens during Expiration?
|
Increase venous flow from lower extremities
Decreases flow from upper extremities |
|
Is the Portal Vein effected during respiration?
|
This is almost no variation with respiration. Flow of an adult is minimally phasic.
|
|
What should happen during a normal Valsalva Maneuver?
|
Augmentation of venous signal should be evident as the patient releases and stops bearing down.
|
|
What should happen during an abnormal Valsalva Maneuver?
|
A venous signal is augmented as the patient bears down
|
|
What are the 4 main Acute DVT findings?
|
Swelling
Pain Redness or erythema Warmth |
|
4 things seen with Chronic venous disease
|
Swelling
Heaviness Discoloration or ulcerations Varicosities |
|
What 3 things make up Virchow's Triad?
|
Trauma
Venous Stasis Hypercoagulability |
|
What is intraluminal thrombi made up of?
Where is it commonly found? |
Predominately composed of RBC trapped within a fibrin web
Commonly found at the cusps or valves or in the soleal sinuses because of stagnation |
|
Paget-Schreotter Syndrome
|
aka Stress or Effort Thrombosis
Involves thrombosis of the subclavian or axillary vein secondary to intense, repetitive activity. Venous component of Thoracic Outlet Syndrome |
|
May-Thurner Syndrome
|
Compression of the left common iliac vein by the right common iliac artery as the artery crosses over it. Sometimes there is enough compression to thicken the vein wall as well as alter flow to the point of thrombosis
|
|
Superior Vena Cava (SVC) Syndrome
|
An obstruction of the SVC, usually by a malignant lesion.
Dyspnea (difficultly breathing) is most common, but also facial and extremity swelling may be seen. |
|
Where is the Gaiter Zone?
|
Distal calf-to-ankle area
|
|
What is Post-Thrombotic or
Postphlebitic Syndrome? |
Combination of chronic swelling, brawny discoloration and ulcer formation in the gaiter zone.
Related to a previous DVT |
|
What are 4 congenital venous diseases?
|
Avalvular (valveless) veins
Incompetent valves Arteriovenous Malformations (AVM) Klippel-Trenaunay Syndrome |
|
Klippel-Trenaunay Syndrome
|
Hypoplastic or absent deep veins
(absent iliacs with varicosities of the superficial system resulting in an enlarged limb) |
|
Portal Hypertension
|
Often the result of an obstruction of blood flow, while usually related to chronic liver disease like cirrhosis, it can also be caused by severe CHF or proximal venous occlusion of hepatic veins or IVC. Elevated pressure results in a reverse pressure gradient that causes portal venous flow away from the liver (hepatofugal)
|
|
Primary Varicose Veins
|
Dilated, tortuous veins that may be hereditary.
From congenital absence or one or more valves. Unrelated to DVTs |
|
Secondary Varicose Veins
|
Cause by obstructive condition like DVT, pregnancy or obesity
|
|
Brawny discoloration
|
Increased venous pressure causes fluid, RBC and fibrinogen to leak into the surrounding tissue. The breakdown of RBC creates a hemosiderin deposit that give the brawny discoloration.
Represents venous insufficiency |
|
Lipodermatosclerosis
|
Thickening and hardening of the skin and can be found in patients with chronic venous insufficiency.
When skin and fat under the skin has been inflamed for years, the tissue becomes hard. Over time the tissue can become depressed, changing shape, "bottle-neck deficiency" |
|
Phlegmasia alba dolens
|
Limb threatening condition results from arterial spasms that occur secondary to extensive, acute iliofemoral vein thrombosis
Limb is very swollen, pallor (pale) and painful |
|
Phlegmasia cerulea dolens
|
Limb threatening complication of an acute iliofemoral vein thrombosis. The severely reduced venous outflow causes a marked reduction in arterial inflow. Tissue hypoxia can develop, leading to gangrene
Limb is very swollen, cyanosis (dark blue) and painful |
|
Describe Venous Ulcers
|
Near medial & lateral malleolus
Mild to severe pain Shallow, irregular shape Venous ooze Stasis changes: Brawny, lipodermatosclerosis, varicosities |
|
Describe Arterial Ulcers
|
Tibial area, toes, boney areas
Severe pain Deep, regular shape Little bleeding Trophic changes: Shiney skin, loss of hair, thickened toenail |
|
What is pitting edema caused from?
|
secondary to fluid retention, electrolyte imbalance, renal dysfunction, CHF or other causes of elevated venous pressure
|
|
What is nonpitting edema caused from?
|
Lymphedema, obstruction in the lymphatic system. Fluid accumulates when lymph nodes are damages or removed.
|
|
What does Impedance Plethysmography (IPG) detect?
|
Can detect thrombi in the iliac, femoral & popliteal veins.
Measures changes in resistance through the calf |
|
What does plethysmography measure?
|
Volume changes
|
|
DC coupling
|
Direct current.
Electrical voltage that is either positive or negative with a current flowing in one direction. Very useful in evaluating the slower-flow states of the venous system. Batteries operate in DC mode |
|
AC coupling
|
Alternating current
Electrical voltage that reverses its polarity ( + or - voltage) 60 times a second. Used in arterial studies, requires more intense changes to produce a measurable signal USA- standard outlets deliver 120 volts of AC current |
|
Describe the Impedance Plethysmography technique
|
Patient supine with calves elevated about heart and heels above calfs. Electrically conductive gel applied to IPG electrodes and placed on proximal and distal portions of calf. Cuff placed on thigh and inflated to 50-60mmHg. Rapid deflate and record outflow patterns. Results based on MVC and MVO on scoring grid.
Thrombosis: reduced venous capacitance and outflow Absence or obstruction based on values on scoring grid. Test should be repeated several times. |
|
Capacitance
|
The maximum filling capability of the veins as venous outflow is momentarily halted by an occluding cuff
Maximum Venous Capacitance (MVC): The maximum rise of the tracing (compared to initial baseline). |
|
Outflow
|
The amount of venous emptying that occurs after deflation of the occluding thigh cuff. Tracing should fall to the baseline within 3 seconds of deflation.
Maximum Venous Outflow (MVO): The measured "fall" at 3 seconds is calculated and plotted on scoring grid. |
|
Describe Strain Gauge Plethysmography (SGP)
|
Used to detect venous obstruction in large veins above the knee.
Measures changes in the circumference of the calf Patient supine, cuff on thigh and mercury-in-Silastic gauge on largest part of calf. Cuff inflated to 50mmHg for 45 seconds and quickly deflated. MVC and MVO plotted on grid. Increased limb volume/increased resistance = positive deflection Decreased limb volume/decreased resistance = negative deflection |
|
Venous Photoplethysmography PPG
|
Documents capillary blood volume, evaluates the presence and severity of venous insufficiency
Contraindicated with acute DVT Patient sitting with limb dangling, PPG placed 5-10cm above medial malleolus. Patient does dorsiflexions to empty veins (or tourniquet or cuff applied). PPG records venous refill time (VRT) |
|
Venous PPG results
|
If venous filling is slow if traveling the normal route, faster if there is retrograde flow.
VRT > 20sec without tourniquet = Normal VRT< 20sec without tourniquet and >20sec with tourniquet above the knee ='s GSV reflux VRT < 20sec without a tourniquet and >20sec with a tourniquet below the knee ='s SSV reflux VRT <20sec with and without a tourniquet ='s insufficiency of the deep system. |
|
Briefly describe Venous Air Plethysmography
|
Determines the presence or absence of venous insufficiency,
Patient supine with heels above heart, Cuff applied to ankle-6mmHg, Veins emptied. Quickly standing on (nontest leg) gravitational pressure. Standing on both legs with 1-toe tip (activate calf pump). Then 1--toe tips. Measure Ejection volume (EV) and Venous Filling Time (VFT). Patient supine, leg elevated and empty the veins. If abnormal, repeat. |
|
Describe Venous Air Plethysmography results
|
Venous Filling Index (rate of venous refilling) VFI=90%VV/VFT
Normal - VFI < 2.0 Mild-Mod - VFI > 2.0-10.0 Severe - VFI > 10.0 Ejection Fraction (EF) measures calf muscle function EF = EV / VV x 100 Normal >60% Residual Volume Fraction (RVF), equivalent to the ambulatory venous pressure RVF = RV / VV Normal <30% |
|
With CW Doppler, which vessels are not always clearly heard. Spontaneity
|
LE: Tibial veins and GSV
UE: Radial & Ulnar Cold vessels, they're more collapsed |
|
Venous Respiratory patterns/phasicity
|
LE: Increase with expiration,
Decrease with inspiration UE: Decrease with expiration Increase with inspiration |
|
What happens to venous flow when the patient is in a slight Trendelenburg position?
|
Venous flow is not as much related to respiration but cardiac dependent.
|
|
What is seen in the outflow vein of a patent dialysis graft?
|
Increased flow velocity and volume flow
No response to distal compression Incompressible vessel Collateral channels evident |
|
Which vessels make up the portal vein?
|
Superior Mesenteric & Splenic Veins make up the Portal Vein and carry blood into the sinusoids of the liver, hepatopetal flow.
Normally phasic flow Pulsatile flow with CHF or fluid overload. Not usually affected with respiration. B-mode - hyperechoic walls |
|
Describe the Hepatic Vein
|
Carries blood from the liver to the IVC, hepatofugal flow.
Flow is minimally phasic, bidirectional or pulsatile appearing doppler signal. B-mode - Walls are not clearly visible like the portal vein. |
|
Flow characteristics of the Renal Veins
|
Minimally phasic, bidirectional or pulsatile appearing doppler signal.
Like the Hepatic Vein |
|
Flow characteristics of the IVC
|
Phasic, bidirectional or pulsatile Doppler signals
|
|
What does continuous flow indicate?
|
Proximal Obstruction
|
|
A compressible vessel with Rouleau formation may indicate what?
|
Proximal obstruction, increased proximal venous pressure, or other processes such as an increase in plasma immunoglobulin.
|
|
Synechiae
|
Linear, echogenic intraluminal striations.
Form as Acute DVTs become chronic |
|
Budd-Chiari Syndrome
|
Results from hepatic vein obstruction. Some abnormal clinical findings include hepatomegaly, abdominal pain, and sudden onset of ascites. The causes of this syndrome are many and vary with regard to the primary site of obstruction.
|
|
D-dimer and what its levels mean
|
D-dimer is a measurable product of the thrombotic process detected on a quantitative blood assay.
Positive result (increased level) - consistent with lysis or breakdown or thrombus Negative result (normal or less than normal) - implies absence of a thrombotic process May be elevated with pregnancy, liver disease, renal disease, cancer or resent surgery. Should not be used on patients already being treated with anti-coagulation therapy. |
|
Contrast Venography
|
Considered the Gold Standard of all venous tests.
2 Types: Ascending: Injected in the dorsum of the foot. Evaluates Acute DVT, congenital venous disease, and or abnormalities, and in the evaluation of chronic venous changes Descending: Injected in the CFV. Used to detect and quantify reversed flow from incompetent venous valves. |
|
Lung Perfusion Scan
VQ Scan |
Lung ventilation, perfusion scan, screening test for the detection of perfusion defects of the lungs. Most commonly PE, usually from the deep system.
Other reasons: emphysema, asthma, pneumonia, cancer, CHF, liver cirrhosis, radiotherapy, multiple bood transfusions and postoperative phenomena. Radioactive contrast medium injected. Results: High, moderate, low probability or indeterminate of PE. |
|
What is the Gold Standard test for a PE?
|
Pulmonary Angiography
However, sometimes a CTA is preformed. |
|
Anticoagulant Therapy for Prophylaxis (Prevention)
|
Low dose unfractionated heparin (5,000 units) every 12 hours before and after surgery decreases the post-op risk of DVT
Low-molecular-weight heparin (Lovenox) may provide a bridge mechanism, provides anticoagulation with Coumadin must be discontinued for an invasive procedure. |
|
Anticoagulant Therapy for an acute DVT or PE
|
Loading dose of 10,000 units of heparin followed by continuous infusion for 5-10 days.
|
|
Heparin
|
Interferes with the formation for a blood clot by slowing the conversion of prothrombin to thrombin, increasing the effect of antithrombin III, and decreasing platelet adhesiveness. It does not dissolve (lyse) and existing thrombus, but helps prevent propagation.
|
|
While on heparin what should the patient's PTT be?
|
1.5-2 times normal
|
|
While on Coumadin, what should the patient's PT be?
|
1.5-2 times normal
|
|
What are the 2 filter devices that may be inserted in the IVC?
What vessel is used to enter through? |
Greenfield filter or a Bird's Nest filter
Jugular Vein or the Femoral Vein |
|
TIPSS
|
Used for Portal Hypertension
Transjugular Intrahepatic Portosystemic Shunt A catheter is inserted in the jugular vein and with fluoroscopic guidance advanced into the right hepatic vein. Inserted just a little further into the portal vein to create a bridge, supported with an endoprosthesis (stent). |
|
QA
Sensitivity |
The ability of a test to detect disease. The abnormal noninvasive test result is confirmed or supported by an abnormal result of the Gold Standard
How many noninvasive results were correctly called positives on the basis of Gold Standard results? # of True + noninvasive results ------------------------------------------------------- # of all + diagnoses by the Gold Standard TP ---------- TP + FN |
|
QA
Specificity |
The ability of a test to identify normality. The normal test result is confirmed or supported by a normal Gold Standard result
Of the Gold Standard (-) how many did you correctly call (-) on the basis of the noninvasive results? # of true (-) noninvasive diagnoses -------------------------------------------------------- # of all (-) diagnoses by the Gold Standard TN --------- TN + FP |
|
QA
Positive Predictive Value |
% of noninvasive test results that accurately predict abnormality.
Of the + noninvasive studies, what % correctly predicted disease as supported by the Gold Standard? # of true + noninvasive tests --------------------------------------- # of all + noninvasive studies TP ---------- TP + FP |
|
QA
Negative Predictive Value |
% of noninvasive test results that accurately predict normality
Of your (-) noninvasive studies, what % correctly predicted the absence of disease as supported by the Gold Standard? # of true (-) noninvasive tests ----------------------------------------- # of all (-) noninvasive studies TN ---------- TN + FN |
|
Accuracy
|
% of correct noninvasive diagnoses
How well does the noninvasive test both detect and rule out disease? Total # of correct tests ------------------------------- Total # of all studies The value falls between Sensitivity & Specificity and Positive & Negative Predictive Values TP + TN ------------------------------ TP + FP + FN + TN |