Vascular Exam 2: Lower Extremity Venous Evaluation

Venous Extremity Evaluation

• Lower extremity venous evaluation examines the deep and superficial venous systems in the legs to rule out deep venous thrombosis (DVT) and evaluate venous insufficiency.

Venous Disease

• Venous disease can be categorized into acute or chronic processes.
• Deep Vein Thrombosis (DVT) is the acute process.
• Post-thrombotic syndrome is the chronic process and a complication of DVT.

Deep Vein Thrombosis (DVT)

• Approximately 500,000 people are affected by DVTs every year.
• Pulmonary Embolisms (PEs) are a potentially lethal complication of acute DVTs.
• DVTs can occur in the upper or lower extremities.
• Risk factors for DVT include:
  • Age (increased risk over 40)
  • Past or current cancer/cancer treatment
  • History of DVT or PE
  • Immobilization
  • Fracture of pelvis, hip, or long bones
  • Myocardial infarction (heart attack)
  • Stroke
  • Congestive heart failure
  • Respiratory failure
  • Pregnancy and postpartum
  • Oral contraceptive use
  • Hormone Replacement Therapy
  • Extensive dissection/damage to veins at major surgery
  • Trauma
  • Hereditary factors (clotting disorders)
  • Obesity
  • Central venous lines, pacemakers, etc.
  • Intravenous drug use

Signs and Symptoms of DVT

• Persistent calf, leg, or arm swelling
• Pain or tenderness of the leg or arm-shoulder region
• Calf pain/arm pain
• Venous distention
• Increased warmth in extremity
• Superficial venous dilation
• Symptoms are typically distal to the affected portion of the vein
• DVTs and PEs may also be asymptomatic

Superficial Venous Thrombosis

• A clot in the superficial veins of the extremities
• Cannot usually cause a PE
• Signs and symptoms:
  • Local erythema (redness)
  • Tenderness or pain
  • Palpable subcutaneous cord

Pulmonary Embolism (PE)

• Signs and symptoms:
  • Dyspnea (shortness of breath)
  • Chest Pain
  • Hemoptysis (spitting of blood from the lungs or bronchial tubes)
  • Sweating
  • Cough

Performing a Venous Study

• Scan the leg twice:
  • First: Scan transversely down the leg, taking two images: one with the vein patent and one with compression
  • Second: Complete a b-mode, color, and Doppler image of each venous segment
  • Doppler image includes phasic flow documentation and augmentation of venous flow
  • Augmentation: compress the lower leg to increase flow up the leg
  • Patient positioning: supine with leg rotated out from the hip like a frog
  • Scanning begins at the crease of the groin
  • Venous segments to be evaluated:
    • Common Femoral Vein (CFV)
    • Greater Saphenous Vein (GSV)
    • Profunda Vein (usually only visible in the high thigh)
    • Femoral Vein (upper, mid, lower/high thigh, mid thigh, low thigh)
    • Popliteal Vein
    • Peroneal, PTV, ATV if required