Lower Extremity Venous Duplex Protocol
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Questions and Answers

What is one of the primary purposes of lower extremity venous duplex imaging?

  • Detection of cancerous lesions
  • Evaluation of respiratory function
  • Assessment of arterial circulation
  • Examination for thrombosis and patency (correct)

Which of the following symptoms is NOT an indication for performing lower extremity venous duplex imaging?

  • Unexplained fever (correct)
  • Shortness of breath
  • Visible varicose veins
  • Pain and edema of the lower extremities

What patient condition could limit the visibility during a lower extremity venous duplex imaging?

  • Obesity (correct)
  • Recent surgery
  • Diabetes
  • Advanced age

What frequency of the transducer is typically used for examining superficial veins?

<p>5-10 MHz (A)</p> Signup and view all the answers

In which position should a patient be placed for venous incompetence evaluation?

<p>Supine (reverse Trendelenburg) (A)</p> Signup and view all the answers

Which of the following factors could affect a patient's ability to tolerate the lower extremity venous duplex exam?

<p>Patient's inability to cooperate (C)</p> Signup and view all the answers

What initial procedure should a technologist follow before conducting the lower extremity venous duplex exam?

<p>Introduce themselves and explain the procedure (A)</p> Signup and view all the answers

What anatomical area is first imaged during the lower extremity venous duplex examination?

<p>The groin (B)</p> Signup and view all the answers

What does the absence of Color and Doppler flow indicate?

<p>It may indicate obstruction cranial to the interrogated vein. (D)</p> Signup and view all the answers

Which position should the patient be in during a Venous Duplex for reflux?

<p>In a 30 degree reverse Trendelenburg position. (A)</p> Signup and view all the answers

What is indicated if Doppler flow shows diminished continuous signals?

<p>Obstruction may be present cranial to the interrogated vein. (A)</p> Signup and view all the answers

What should be documented as part of the image representation?

<p>Transverse grayscale images of veins along with documented flow. (D)</p> Signup and view all the answers

What maneuvers are recommended to evaluate superficial veins for reflux?

<p>Valsalva maneuver and augmentation techniques. (A)</p> Signup and view all the answers

What does the presence of collateral veins indicate?

<p>There is a potential obstruction of the anatomical vein. (C)</p> Signup and view all the answers

Which of the following must be documented during spectral Doppler evaluation?

<p>Duration of retrograde flow and response to distal augmentation. (D)</p> Signup and view all the answers

What is a notable characteristic of veins with a GSV size greater than 5.4 mm?

<p>They may represent significant venous reflux. (A)</p> Signup and view all the answers

What is necessary to assess when a femoro-popliteal DVT is present?

<p>The deep femoral vein for patency (C)</p> Signup and view all the answers

What constitutes a complete examination in venous duplex imaging?

<p>Bilateral examination (C)</p> Signup and view all the answers

Which of the following correctly describes a characteristic of normal venous flow?

<p>Veins are fully compressible (D)</p> Signup and view all the answers

What must be included in the documentation for a venous duplex exam?

<p>Transverse grayscale images of several veins (D)</p> Signup and view all the answers

In the assessment of thrombosis, veins that display no compressibility indicate what?

<p>Potential thrombus presence (D)</p> Signup and view all the answers

What is a feature of abnormal venous flow that a technologist should note?

<p>Echogenicity may vary based on thrombus age (B)</p> Signup and view all the answers

Which of the following is an essential component of spectral Doppler documentation?

<p>Waveforms from both common femoral veins (D)</p> Signup and view all the answers

What is the significance of additional images when performing venous duplex exams?

<p>They help document suspected thrombus or reflux when requested (A)</p> Signup and view all the answers

What is the primary purpose of compressing the femoral vein every 2-3 cm during the examination?

<p>To ensure wall-to-wall compressibility of the vein (B)</p> Signup and view all the answers

Where is the transducer placed to examine the popliteal vein?

<p>Behind the knee in the popliteal fossa (A)</p> Signup and view all the answers

What is assessed in the gastrocnemius veins along with compressibility?

<p>Color flow and pulse Doppler signals (A)</p> Signup and view all the answers

Which veins are specifically examined for reflux evaluation?

<p>Great saphenous, small saphenous, accessory veins, and perforators (B)</p> Signup and view all the answers

In what position is the anatomical path for reflux evaluation typically followed?

<p>Reverse Trendelenburg and standing position (C)</p> Signup and view all the answers

What imaging technique is used to demonstrate spontaneous flow in the venous system?

<p>Color Doppler and pulsed Doppler imaging (D)</p> Signup and view all the answers

Which muscles obscure the soleal veins, making them difficult to recognize?

<p>Gastrocnemius muscles (D)</p> Signup and view all the answers

What should the examiner note when assessing veins for visible stasis changes?

<p>Visible varicosities and stasis changes such as ulcerations (B)</p> Signup and view all the answers

Flashcards

Compression Technique

Applying pressure to veins during ultrasound to assess their compressibility.

Transverse Plane

Viewing the vein from the side, like looking at a slice of bread.

Deep Venous System

The network of veins within the leg's muscles, responsible for returning blood to the heart.

Superficial Venous System

The veins closer to the skin's surface, not within muscles.

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Wall-to-Wall Compressibility

Veins that collapse completely when pressure is applied, indicating normal function.

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Spontaneity

The natural flow of blood within a vein without compression.

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Phasicity

The rhythm of blood flow within a vein, which changes with breathing.

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Augmentation

Increased blood flow in a vein in response to distal compression.

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Venous Duplex for Thrombosis

A type of ultrasound exam that uses sound waves to visualize veins and blood flow to look for blood clots (thrombosis) and check if the veins are open (patency).

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Common Femoral Vein

A major vein in the leg that carries deoxygenated blood from the legs back to the heart.

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Saphenofemoral Junction

The point where the great saphenous vein (superficial) connects to the common femoral vein (deep).

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Proximal Femoral Vein

The upper part of the femoral vein closer to the groin.

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Mid Femoral Vein

The middle section of the femoral vein.

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Distal Femoral Vein

The lower part of the femoral vein closer to the knee.

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Popliteal Vein

A major vein behind the knee.

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Normal Venous Flow

Blood flowing smoothly and consistently through the veins, indicating no obstructions.

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Lower Extremity Venous Duplex

A non-invasive ultrasound procedure used to assess veins in the legs for conditions such as blood clots (thrombosis), venous reflux (backward flow of blood), and vein health before surgery.

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Indications for Venous Duplex

Reasons for performing a lower extremity venous duplex exam include swelling, pain, visible veins, leg heaviness, and suspected blood clots.

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Venous Thrombosis

A blood clot that forms inside a vein, potentially restricting blood flow and causing swelling, pain, and other symptoms.

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Venous Reflux

Backflow of blood in a vein, typically due to faulty valves. This can lead to swelling, pain, and varicose veins.

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Preoperative Vein Mapping

A Venous duplex used to identify healthy veins suitable for grafting during surgery. This is important for reconstructive procedures.

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Limitations of Venous Duplex

Conditions that make it difficult to perform a clear and accurate venous duplex exam, including obesity, casts, severe edema, and limited patient mobility.

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Saphenofemoral Junction (SFJ)

The point where the greater saphenous vein joins the common femoral vein in the groin. This is a common site for blood clots and varicose veins.

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Compression Technique in Venous Duplex

Applying pressure to a vein during the exam to assess its ability to close and prevent backflow of blood. This is used to evaluate valve function.

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Color Doppler Absence

When color Doppler signals are absent or incomplete in a vein, suggesting possible blockage or obstruction.

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Luminal Encroachment

A narrowing of the vein's internal space, often due to blood clots, inflammation, or other obstructions.

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Intraluminal Material

Echogenic (bright) materials within the vein, like clots or webs, indicating possible obstruction.

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Valsalva Maneuver

A technique used to assess venous reflux by straining as if having a bowel movement, increasing pressure in the veins.

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Proximal Augmentation

A technique used to assess venous flow by squeezing a vein distally, sending a wave of blood towards the transducer.

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Distal Augmentation

A technique used to assess venous flow by squeezing a vein proximally, sending a wave of blood towards the transducer.

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Collateral Veins

New veins that develop to bypass a blocked vein, providing alternative pathways for blood flow.

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Study Notes

Lower Extremity Venous Duplex Protocol

  • Purpose: To examine for thrombosis, patency, venous reflux, and preoperative vein mapping.

Indications

  • Swelling, pain, tenderness.
  • Palpable cord.
  • Post-venous interventional procedures.
  • Symptoms of pulmonary embolism.
  • Venous stasis dermatitis or pigmentation.
  • Venous stasis ulcers.
  • New lower extremity pain while on anticoagulation therapy.
  • Recurrent lower extremity swelling.
  • Visible varicose veins.
  • Pain and edema of lower extremities.
  • Venous claudication.
  • Preoperative evaluation for venous insufficiency.
  • Preoperative superficial vein evaluation for vein harvesting.

Contraindications and Limitations

  • Obesity.
  • Casts, dressings, or open wounds.
  • Severe edema.
  • Limited patient mobility.
  • Patient's inability to cooperate/tolerate the exam.

Instrumentation

  • Appropriate duplex instrumentation with appropriate frequencies for vessels being examined.
  • Linear 5-10 MHz transducer (depending on vessel depth).
  • Lower frequency transducer for deeper structures or edematous tissue.

Patient Positioning and Exam Techniques

  • Technologist introduces themselves and explains the procedure, considering the patient's age and mental status.
  • Patient's questions and concerns about the lower extremity venous evaluation are addressed.
  • Patient positioned supine (reverse Trendelenburg for venous incompetence evaluation).

Image Representation

  • Abnormal unilateral exams: Warrant contralateral extremity evaluation, including CFV, FV, and Popliteal.
  • Femoro-popliteal DVT: Deep femoral vein evaluation for patency.
  • Bilateral evaluation: Considered complete. Unilateral exam possible if symptoms are isolated to one extremity.

Diagnostic Criteria and Interpretation for Thrombosis

  • Observe normal and abnormal tissues, structures, and blood flow for optimal exam quality.
  • Analyze sufficient data to direct patient management.
  • Document normal vein compressibility, full/spontaneous flow, and absence of thrombus.
  • Document abnormal findings (thrombus, diminished/absent flow, etc.).

Venous Duplex for Reflux

  • Patient positioned in at least 30-degree reverse Trendelenburg.
  • Valsalva maneuver and/or proximal/distal augmentation techniques utilized.
  • Superficial veins evaluated for reflux in standing position, if necessary (GSV >5.4mm, SSV >4mm when reflux is not represented with Valsalva or augmentation maneuvers).
  • Document transverse grayscale images (with/without transducer), including:
    • common femoral vein,
    • saphenofemoral junction,
    • proximal femoral vein,
    • mid femoral vein ,
    • distal femoral vein -great saphenous vein
  • Spectral Doppler to evaluate venous flow. Include baseline flow and response to distal augmentation.

Preoperative Venous Mapping

  • Assess patency and diameter of great and small saphenous veins.
  • Document compression maneuvers on common femoral, femoral, and popliteal veins.
  • Take digital representative images.
  • Document areas of suspected pathology, including calf muscle and superficial veins, in additional images.
  • Document technical limitations/deviations in the report.

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Lower Extremity Venous Duplex Protocol PDF

Description

This quiz covers the protocol for conducting a duplex examination of the lower extremities, focusing on thrombosis detection, venous reflux, and vein mapping. It includes indications for the procedure, potential contraindications, and necessary instrumentation for effective imaging. Test your knowledge on this vital assessment tool for vascular healthcare.

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