Detecting Deep Venous Disease with Duplex Ultrasound
-
Upload
vein-global -
Category
Health & Medicine
-
view
1.199 -
download
3
description
Transcript of Detecting Deep Venous Disease with Duplex Ultrasound
![Page 1: Detecting Deep Venous Disease with Duplex Ultrasound](https://reader036.fdocuments.us/reader036/viewer/2022081400/554b5d21b4c905793d8b500c/html5/thumbnails/1.jpg)
Disclosure Joseph Zygmunt, Jr., RVT, RPhS
I disclose the following financial relationship(s):
•Employment: Covidien Inc.
![Page 2: Detecting Deep Venous Disease with Duplex Ultrasound](https://reader036.fdocuments.us/reader036/viewer/2022081400/554b5d21b4c905793d8b500c/html5/thumbnails/2.jpg)
Detecting Deep Venous Disease with Duplex Ultrasound Joseph Zygmunt, Jr. RVT, RPhS
IVC 2011
![Page 3: Detecting Deep Venous Disease with Duplex Ultrasound](https://reader036.fdocuments.us/reader036/viewer/2022081400/554b5d21b4c905793d8b500c/html5/thumbnails/3.jpg)
“Duplex Ultrasound has become the reference standard in assessing the morphology and hemodynamics of the lower limb veins”
Coleridge-Smith et al. Duplex Ultrasound Investigation of the Veins in Chronic Venous Disease of the Lower Limbs – UIP Consensus Document. Part I Basic Principles. Eur J Vasc Endovasc Surg 2006.
Cavezzi et al. Duplex Ultrasound Investigation of the Veins in Chronic Venous Disease of the Lower Limbs – UIP Consensus Document. Part II Anatomy. Eur J Vasc Endovasc Surg, 2006
“Duplex Ultrasound is the most significant contribution made to Phlebology in the last ten years” ~Dr. Hugo Partsch 2004
Deep Veins …….Some ask: Why Bother?
![Page 4: Detecting Deep Venous Disease with Duplex Ultrasound](https://reader036.fdocuments.us/reader036/viewer/2022081400/554b5d21b4c905793d8b500c/html5/thumbnails/4.jpg)
![Page 5: Detecting Deep Venous Disease with Duplex Ultrasound](https://reader036.fdocuments.us/reader036/viewer/2022081400/554b5d21b4c905793d8b500c/html5/thumbnails/5.jpg)
Deep Venous System
Examination of the deep venous system is considered an essential step in the evaluation of ANY phlebology patient
Primary system for venous return to the heart
Examination the superficial system only is inadequate
Evaluate for DVT – ( acute, sub-acute and chronic)
Evaluate for insufficiency (axial or segmental deep)
Change in Dogma -
Deep disease is no longer the “kiss of death”
Early intervention and clot load removal
![Page 6: Detecting Deep Venous Disease with Duplex Ultrasound](https://reader036.fdocuments.us/reader036/viewer/2022081400/554b5d21b4c905793d8b500c/html5/thumbnails/6.jpg)
IVUS
Iliac vein obstruction ubiquitous and often silent in general population
C3-C6 patients with primary and postthrombotic CVI - >90% with IVUS
Early restoration of iliac vein patency in the acute phase is becoming the norm to prevent post thrombotic syndrome
Lurie et al, Invasive treatment of deep venous disease,
a UIP consensus; Int Angiol 2010; 29:199-204
![Page 7: Detecting Deep Venous Disease with Duplex Ultrasound](https://reader036.fdocuments.us/reader036/viewer/2022081400/554b5d21b4c905793d8b500c/html5/thumbnails/7.jpg)
Anatomy : Deep System
Tibial
–Anterior –Posterior
Peroneal Gastrocnemius Popliteal
![Page 8: Detecting Deep Venous Disease with Duplex Ultrasound](https://reader036.fdocuments.us/reader036/viewer/2022081400/554b5d21b4c905793d8b500c/html5/thumbnails/8.jpg)
Anatomy : Deep System
Popliteal Femoral Vein (of the thigh)
– NOT SFV Deep (profunda)Femoris Common Femoral Vein External Iliac
Duplications in the FV and POP
can result in missed DVT
![Page 9: Detecting Deep Venous Disease with Duplex Ultrasound](https://reader036.fdocuments.us/reader036/viewer/2022081400/554b5d21b4c905793d8b500c/html5/thumbnails/9.jpg)
Patient Position
Hip slightly rotated
Supine (slight tilt on
table)
Incorrect positioning can lead to inaccurate assessment
Consider: ergonomics!
![Page 10: Detecting Deep Venous Disease with Duplex Ultrasound](https://reader036.fdocuments.us/reader036/viewer/2022081400/554b5d21b4c905793d8b500c/html5/thumbnails/10.jpg)
Deep System Diagnostic Criteria
Three complementary modes
![Page 11: Detecting Deep Venous Disease with Duplex Ultrasound](https://reader036.fdocuments.us/reader036/viewer/2022081400/554b5d21b4c905793d8b500c/html5/thumbnails/11.jpg)
Common Femoral Vein
Normal Findings – good compressibility
Split screen documentation
![Page 12: Detecting Deep Venous Disease with Duplex Ultrasound](https://reader036.fdocuments.us/reader036/viewer/2022081400/554b5d21b4c905793d8b500c/html5/thumbnails/12.jpg)
Femoral Vein
not superficial femoral vein
![Page 13: Detecting Deep Venous Disease with Duplex Ultrasound](https://reader036.fdocuments.us/reader036/viewer/2022081400/554b5d21b4c905793d8b500c/html5/thumbnails/13.jpg)
Popliteal Vein Note: vessel orientation
![Page 14: Detecting Deep Venous Disease with Duplex Ultrasound](https://reader036.fdocuments.us/reader036/viewer/2022081400/554b5d21b4c905793d8b500c/html5/thumbnails/14.jpg)
Post. Tibial and Peroneal Veins
Paired in calf
Anterior Tibial: omitted routinely
![Page 15: Detecting Deep Venous Disease with Duplex Ultrasound](https://reader036.fdocuments.us/reader036/viewer/2022081400/554b5d21b4c905793d8b500c/html5/thumbnails/15.jpg)
External Compression performed every 1-2 cm
along entire length of vein
90º to vein
(anterior and posterior
approach)
Don’t bounce the probe –
Use a slow deliberate
compression technique
Confirmation with other
modalities
![Page 16: Detecting Deep Venous Disease with Duplex Ultrasound](https://reader036.fdocuments.us/reader036/viewer/2022081400/554b5d21b4c905793d8b500c/html5/thumbnails/16.jpg)
Multiple Views to fully understand the pathology
![Page 17: Detecting Deep Venous Disease with Duplex Ultrasound](https://reader036.fdocuments.us/reader036/viewer/2022081400/554b5d21b4c905793d8b500c/html5/thumbnails/17.jpg)
DVT RT CFV
![Page 18: Detecting Deep Venous Disease with Duplex Ultrasound](https://reader036.fdocuments.us/reader036/viewer/2022081400/554b5d21b4c905793d8b500c/html5/thumbnails/18.jpg)
Spectral Doppler Spectral Doppler
Spontaneous flow Phasic flow with respiration (large veins)
cease with deep breath inspiration Flow also ceases with the Valsalva
maneuver Flow augmentation with distal compression Unidirectional flow (toward the heart) Non-pulsatile
Importance of contralateral CFV analysis
![Page 19: Detecting Deep Venous Disease with Duplex Ultrasound](https://reader036.fdocuments.us/reader036/viewer/2022081400/554b5d21b4c905793d8b500c/html5/thumbnails/19.jpg)
Valsalva:
“ a well performed Valsalva maneuver detects significant reflux in major veins until a competent valve is detected.….
Like descending venography, detection of reflux distal to competent valves may not be detected with these techniques”
Talbot, S Vascular Ultrasound Today 9(1): 1-28, 2004
![Page 20: Detecting Deep Venous Disease with Duplex Ultrasound](https://reader036.fdocuments.us/reader036/viewer/2022081400/554b5d21b4c905793d8b500c/html5/thumbnails/20.jpg)
A continuous venous waveform is abnormal – recommend study of proximal veins
Normal
phasic
![Page 21: Detecting Deep Venous Disease with Duplex Ultrasound](https://reader036.fdocuments.us/reader036/viewer/2022081400/554b5d21b4c905793d8b500c/html5/thumbnails/21.jpg)
Normal Color Doppler
Femoral Vein
thigh Venous Confluence
Color images in long axis to document patency of vein
![Page 22: Detecting Deep Venous Disease with Duplex Ultrasound](https://reader036.fdocuments.us/reader036/viewer/2022081400/554b5d21b4c905793d8b500c/html5/thumbnails/22.jpg)
Color Doppler Abnormal
Incomplete filling – no color = no flow
![Page 23: Detecting Deep Venous Disease with Duplex Ultrasound](https://reader036.fdocuments.us/reader036/viewer/2022081400/554b5d21b4c905793d8b500c/html5/thumbnails/23.jpg)
Case Study: Partial Compression
What about the spectral doppler?
Whats
going
On?
![Page 24: Detecting Deep Venous Disease with Duplex Ultrasound](https://reader036.fdocuments.us/reader036/viewer/2022081400/554b5d21b4c905793d8b500c/html5/thumbnails/24.jpg)
Rt CFV Continuous Flow
![Page 25: Detecting Deep Venous Disease with Duplex Ultrasound](https://reader036.fdocuments.us/reader036/viewer/2022081400/554b5d21b4c905793d8b500c/html5/thumbnails/25.jpg)
Walking Doppler
Venous Stenosis
![Page 26: Detecting Deep Venous Disease with Duplex Ultrasound](https://reader036.fdocuments.us/reader036/viewer/2022081400/554b5d21b4c905793d8b500c/html5/thumbnails/26.jpg)
Contralateral Comparison infra inguinal clues
Full Easy Compression Contralaterally
![Page 27: Detecting Deep Venous Disease with Duplex Ultrasound](https://reader036.fdocuments.us/reader036/viewer/2022081400/554b5d21b4c905793d8b500c/html5/thumbnails/27.jpg)
Report: What to document Transverse Gray Scale Spectral Wave Forms CFV, SFJ Right and Left CFV Prox, Mid, and Distal FV Pop V Pop V Post Tib V Peroneal V additional images as needed additional as per protocol additional as per protocol *iliacs, GSV, SSV, prox Profunda, gastrocs, soleals, ant tibs,
Perfs
ICAVL Imaging Standards 2010
Protocol: DVT
![Page 28: Detecting Deep Venous Disease with Duplex Ultrasound](https://reader036.fdocuments.us/reader036/viewer/2022081400/554b5d21b4c905793d8b500c/html5/thumbnails/28.jpg)
Deep Reflux vs Siphon affect?
Is deep reflux segmental or axial?