Vein Mapping

Front 1

what is the longest vein in the body?what is it's course?

Back 1

GSV(greater saphenous)
-it's distal end is anterior to the medial malleolus
-courses along the anteriomedial aspect of the leg to join the CFV at the groin crease
-the terminal junction is called the saphenofemoral junction

Front 2

Explain the valves in the GSV

Back 2

-contains 10-13 valves
-one is located at the saphenofemoral junction
-one is located 2-5cm distal to this juction
-one is located at the junction of the medial branch
-1-2 valves are located mid thigh
-one is located at the suprageniculate level
-3-6 valves are located in the calf

Front 3

what are some alternate venous conduates for potential bypass?

Back 3

-lesser saphenous
-superficial arm veins

Front 4

explain the course of the LSV, and its valves

Back 4

aka short saphenous, small saphenous, or external saphenous
-distal end is post to lat. malleolus
-ascends in the subutaneous tissue of the calf btw the heads of the gastrochnemius muscles
-terminates in popiteal vein
-contains 7-13 valves which are more closely spaced than the GSV

Front 5

Explain the course of the cephalic vein?

Back 5

-begins along radial aspect of the hand
-communicates with basilic vein in the antecubital fossa via the medial cubital vein
-asc. laterall and empties into the axillary vein

Front 6

explain the course of the basilic vein

Back 6

-ulnar side of the wrist
-travels medially to join the brachial vein at the mid to upper 1/3 of the arm

Front 7

what is an important qualification for equipment for vein mapping
-what probes can be used?

Back 7

-be able to measure in tenths of a millimeter
-have the ability to magnify

Probes:
-linear array avoid ringdown in the nearfield
-7mHz provides the best resolution

Front 8

what supplies do you need to do vein mapping?

Back 8

-washcloths-to remove gel to make it easier to mark the leg
-indelible markers
-warm gel-avoid vasoconstriction
-tourniquet-to aid in examination of arm veins.

Front 9

what position should patients be placed in for vein mapping?

Back 9

-the same position they will be in for the operation
-usually supine in reverse trendellenberg position

Front 10

before you begin vein mapping, what should you check for w/ the patients veins?

Back 10

-DVT-to make sure the superficial system is not needed for an occluded system

Front 11

when measuring the diameter of a vein for vein mapping, how should the calipers be placed? where should measurement be made?

Back 11

outer to outer
-high thigh
-mid thigh
-knee
-calf
-ankle

Front 12

if a vein measures 2.5 mm by u/s, how much should it theoretically be able to dialate under arterial pressure?

Back 12

to 4mm

Front 13

what should you look for when tracking the GSV?

Back 13

-Ant. lateral vein-upper thigh
-posteromedial vein-mid thigh
-post. arch vein-below the knee

Front 14

explain how to mark valves and tributaries?

Back 14

-best identified in the trx plane
-valve sites may be identified by observing the dialation of the vein at the sinus(don't always see leaflets)
-tributaries should be marked according to their direction
-perforators are identified by their communication w/ the deep venous system

Front 15

explain how to mark the GSV a vein?

Back 15

-marks should be made every 2 cm
-vein should be centered in the middle of the u/s screen
-mark skin w/ straw, use a washcloth to wipe off gel, then mark the skin w/ an undelible marker
-dry the leg completely when finished, and connect the dots
-if a section is<2mm, it should be represented by a dotted line
-if a dual system is seen, the larger one should be a solid line, and the smaller one should be a dotted line

Front 16

explain how to mark the LSV?

Back 16

-done in the same way as the GSV
-measurements made at knee, calf and ankle
-since LSV is not used insitu, valves and tributaries don't need to be marked

Front 17

explain the technique for marking the superficial arm veins>

Back 17

-similar to leg veins, except tournquet is used to make identification easier
-valves and tributaries do not need to be marked

Front 18

where is the cephalic vein measured?

Back 18

-upper arm
-mid arm
-antecubital fossa
-forarm
-wrist
-anatomic variations exist(most common is absent or atretic vein in upper or lower arm)

Front 19

why must veinpuncture or placement of IV's be avoided in the arm veins that are marked?

Back 19

-can change the way veins are displayed

Front 20

why is vein mapping done?

Back 20

-make it easier for surgeons
-20-30% of surgically exposed saphenous veins are inadequate for bypass, so vein mapping decreases the amount of dissection, and therefor wound complications
-GSV mapping is more accurate than physical examination, and less expensive than venography
-allows for preoperative planning w/ identification of anatomic variants including double systems

Front 21

what are the indications for vein mapping?

Back 21

-harvesting the saphenous, sephalic, basilic or radial artery for coronary artery bypass grafts(CABG)
-harvesting the greater or lesser saph. for lower extremity bypass grafts
-determining complete or incomplete palmar arch

Front 22

what are the phases for harvesting veins for CABG?

Back 22

-determining suitability of vein
-mapping the vein

Front 23

T/F varicose veins can be used for grafting?

Back 23

false-vener used

Front 24

Explain artery grafts?

Back 24

-often the graft of choice over veins due to the ability to anastomose the artery to the native vessels and better longevity

Front 25

what arteries may be used for artery grafting?

Back 25

-mammary or radial artery

Front 26

why couldn't arteries be used in the past for bypass grafts, why is this different now?

Back 26

-due to high incidence of vasospasm post surgery causing failure of the graft or acute ishemia of the tissue it was suppose to supply
-medications are now used to reduce vasospasm
-procedures soak the harvested artery in a solution prior to grafting to prevent vasospasm

Front 27

btw the radial and mammary artery, which one does u/s map more often?

Back 27

mammary

Front 28

what is the function of duplex u/s in radial artery assessment?

Back 28

r/o stenosis or incomplete palmar arch in the hand

Front 29

Differentiate btw limited mapping, and full mapping?

Back 29

-limited mapping-when ther will be an open incision along the leg, and information regarding branches, and perforators are not NB
-full mapping-information is needed about the perforators and branches

Front 30

What is the purpose of radial artery harvesting? what are the advatages of using it over the saphenous vein?

Back 30

-gaining popularity for CABG or some plastic surgeries
-usually taken from the non-dominent arm

ADVANTAGES(over saphenous):
-appropriate diameter
-thicker wall, less intimal hyperplasia
-availability

Front 31

what are the contraindications for using the radial artery for CABG?

Back 31

-ishemic digits
-raynaud's syndrome
-ipsilateral athero-occlusive disease in the arm
-sclerotic, atresic or occluded radial artery
-incomplete palmar arch

Front 32

explain how the test is done for palmar arch patency?

Back 32

-basic upper arm study including digital pressures to r/o underlying stenosis
-PPG applied to thumb and 5th finger
-baseline arterial waveforms done
-compression of radial and ulnar arteries are done(both are compressed to ensure compression of the radial artery)
-record flatline waveform
-release ulnar artery, but continue pressing radial artery
-record waveform after release
-procedure may be repeated w/ ulnar artery compression

Front 33

what are the baseline PVR parameters for the resting digit study?

Back 33

-digital BP should be within 20mmHg of the braqchial pressure
-digital/brachial ratio>0.8
-waveform should demonstrate upstroke time<0.2 seconds, and dicrotic notch

Front 34

when both the radial and ulnar artery are occluded, and there is a flatline on PPG, what does this indicate? IF the flatline persists when the ulnar artery is released, what does this indicated?

Back 34

Flatline=full occlusion
Flatline when ulnar is release=dominent radial artery

Front 35

if the ulnar artery is compressed, and flow is diminished bilaterally what does this indicate regarding the possiblity for CABG?

Back 35

radial artery cannot be used for harvesting

Front 36

explain the procedure for radial artery duplex imaginge?

Back 36

-identify orign at the brachial artery
-measure diameter
-scan the course of the artery and measure distally
-average=2.8-men; 2.4mm=women
-make sure diameter is at least 2mm, but preferably >2.5-3mm
-not the course and any deviations from normal

Front 37

Explain how visual inspection and venography are useful for vein mapping?

Back 37

Visial inspection-cannot reveal diameter of vessel or duplications
Venography:
-can determine patency, location of tributaries, diameter, and double systems
-cannot map vessel on skin
-painful-risk of dye-induced phlebitis

Front 38

what are the indications for vein mapping?

Back 38

-decreased amount of dissection
-decreased wound complications
-increased accuracy
-less expensive than venography

Front 39

what position should the patient be in for upper extremity vein assessment?

Back 39

-head elevated
-arm in dependant position
-may posiiton on pillow for comfort

Front 40

where do you begin mapping the GSV?

Back 40

in transverse at the saphenofemoral junction