Lower Extremity Peripheral Veins Second Half Powerpoint

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1

Radial and ulnar

Radial and ulnar

Deep Veins:

Deep veins (superficial and deep palmar venous arches) draining the hand form paired ____ and ____ veins.

____ veins accompany radial artery, and ____ veins accompany ulnar artery in forearm.

2

Antecubital; brachial

Brachial

Deep Veins:

Near _____ fossa, radial and ulnar veins join to form ____ veins.

____ veins are paired veins that travel with brachial artery in the upper arm.

3

Single

Basilic

Cephalic

Axillary Vein: Axillary vein is a ____ vein.

Begins where ____ vein joins brachial veins in upper arm and terminates beneath clavicle at outer border of first rib

Receives ____ vein near its termination

4

Axillary

Jugular; innominate

Inferior; anterior

Subclavian Vein: Subclavian vein is continuation of the _____ vein.

Extends from outer border of first rib to inner end of clavicle, where it joins the internal ____ vein to form the _____ vein

Lies beneath the clavicle and is ____ and _____ to subclavian artery

5

Vertically; superior

Superficial; right

Vertebral; mammary; and thyroid

Right and Left Innominate (Brachiocephalic) Veins: On right side, innominate vein courses almost _____ downward joining the left innominate vein just below first rib to form the ___ vena cava.

Lies ____ and to the ____of the innominate artery

Right innominate vein receives the right ____, internal ____, and inferior ____ veins.

6

Longer

Sternum; SVC (superior vena cava)

Vertebral; mammary; thyroid; intercostal

Right and Left Innominate (Brachiocephalic) Veins: Left innominate vein is ____ than right vein.

Courses from left to right side of chest beneath ____ and at slight downward angle to join right innominate vein to form ____

Receives left ____, internal _____, inferior ____, and left superior ____ veins

7

Primary

Two; fascia; fascia

Superficial Veins:

In the upper extremity, superficial venous system is the ____ route of drainage.

Lie beneath the ____ and between ___ layers of superficial ____ and outside deep investing ____

8

Thumb

Biceps; deltopectoral; axillary

Cephalic Vein:

Cephalic vein begins on ____ side of the dorsum of the hand.

Courses along outer border of ____ muscle and along ____ groove, penetrates deep fascia at variable levels, and joins _____ vein just below clavicle

9

Small finger

Large; biceps; axillary

Basilic Vein:

Basilic vein originates on ____ _____ side of dorsum of hand

Is ____; courses medially along inner side of ____ muscle, pierces deep fascia, enters brachial veins in upper arm, and becomes ____ vein

10

Vessel

Phasic; compression

Common femoral

Imaging Characteristics of Normal Veins: ____ walls collapse with light or moderate pressure by transducer on skin.

____ low-velocity Doppler signals augment with distal limb _____.

_____ _____ vein changes in size with respiration.

11

Not

Triphasic

Pulsation

Imaging Characteristics of Normal Arteries:

Vessel does ____ collapse with light pressure by transducer on skin

____ high-velocity Doppler signal

____ of vessel walls is present

12

Spontaneous

Pulsatility; pulsatile

Imaging Characteristics of Normal Veins: _____: Flow is present without augmentation maneuvers.

______: _____ signals should be present in jugular, subclavian, innominate, and SVC because of retrograde transmission of right atrial pressure.

13

Respiratory Phasicity

Augmentation

Imaging Characteristics of Normal Veins: _____ _____: Blood flow velocity changes with respiration. In upper extremity (central veins), venous Doppler signal will increase with inspiration and decrease with expiration.

_____: Blood flow velocity increases with distal limb compression or with release of proximal limb compression (limited in upper extremity examination

14

30

Below

Patient Positioning: Supine with head/chest elevated ___ degrees

Legs ____ the heart

Leg being scanned should be bent outward slightly

For Popliteal vein or calf veins, might have patient roll toward or away from you slightly

15

...

Spectral Analysis:

  • Spontaneous
  • Patent
  • Phasic
  • Augmentation
  • Valsalva for reflux
  • Pulsatility- abnormal unless subclavian vein
  • Suggests fluid overload (over-hydration), increased venous pressure (CHF)
16

Bypass

Vein Mapping: Purpose of superficial vein mapping is to determine vein’s suitability for use as ____ conduit and to identify its anatomic route.

Is usually performed before lower extremity arterial bypass or coronary bypass operations

Veins 2-2.5 mm

17

Accurate

Avoids

Vein Mapping: ____ mapping of location of veins is important when surgeons plan an in situ bypass graft of lower extremity or when harvesting vein.

Preoperative vein mapping ____ exposing inadequate veins, which in turn decreases operative time and the possibility of wound complications from unnecessary incisions.

18

Presence and location

Insufficiency

Symptoms

Venous Reflux Testing: Purpose of venous reflux testing is to identify ____ and ______ of incompetent venous valves.

Patients that suffer from chronic venous ______ may benefit from study.

_____ include chronic leg swelling, induration, and sometimes ulcers.

19

Hypertension

Ulceration

Complications of Venous Insufficiency:

Chronic venous _____

Venous ______ (medial)

20

Difficult

Not

Calf Vein Imaging: Why examine calf veins in patients at high risk for developing DVT or in patients suspected of DVT?

Controversy centers on three distinct points:

  • Calf veins can be ____ to image in many patients.
  • Physicians often do ____ treat an isolated calf clot; patients with calf clot are unlikely to have signs or symptoms of pulmonary embolism.
  • Patients can be followed serially.
21

Arteriography; anticoagulation

Assessment of Pulmonary Embolus: Why examine lower extremities with venous duplex imaging if patient has signs and symptoms of pulmonary embolus?

Clinicians may not order pulmonary _____ in patients if venous duplex imaging detects DVT in patients suspected of PE; _____ therapy may be initiated.

22

Lower

Half; not

Assessment of Pulmonary Embolus: Majority originate from _____ extremity

Using venous duplex imaging to clarify indeterminate lung scan may help confirm clinical suspicion.

Approximately ___ of patients with documented pulmonary embolism by pulmonary arteriography do ___ have clots in legs.

23

Popliteal

Synovial; knee

Osteoarthritis; rheumatoid

Baker's Cyst: Is a common fluid collection that can be found in ___ fossa

Is a collection of ____ fluid associated with the ___ joint

Excess fluid can be related to any type of arthritis, more commonly _____ and _____ arthritis, or trauma such as cartilage tears

24

DVT

Baker's Cyst:

Unilateral or bilateral

Symptoms can mimic ____ symptoms with swelling and tightness behind knee, or severe pain in upper calf in cases of cyst rupture and dissection into upper calf muscles

25

DVT

First; second

Other Pathology:

Abscesses, cellulitis, and hematomas can cause focal areas of redness and swelling that may mimic symptoms of ____.

Proving no DVT in deep venous system is ___ goal; evaluating focal area is ____

Small fluid collections may be seen within tissue or muscle planes.

26

Groin; DVT

Documented

Lymph Nodes: Lymph nodes in ____ can sometimes be mistaken for ____ in common femoral or external iliac veins.

Visualizing these structures in transverse and sagittal excludes them from venous pathology.

Enlarged lymph nodes should be ____ when seen.

27

Transverse

Longitudinal

Venous Duplex Imaging Guidelines:

  • Take patient history.
  • Be familiar with venous anatomy, physiology, and pathology.
  • Optimize gray scale.
  • Only use ____ view for compression technique.
  • Use _____ view to obtain Doppler signals.
28

Large

Longitudinal

Pulsatility

Venous Duplex Imaging Guidelines:

  • Use ____ Doppler sample volume size and low-velocity scale.
  • Use ____ view to obtain color Doppler images.
  • Upper extremities: Document ____ in Doppler signal, and compare right and left sides.
  • Establish institutional diagnostic criteria.
29

Brightly; rigid; well; vein

Lightly; spongy; poorly; vein

Observable Characteristics of a Thrombus:

Old (chronic) - ____ echogenic, ____ texture, ____ attached, and contracted ____

New (acute) - ____ echogenic, ____ texture, ____ attached, and dilated ___ (if obstructed)