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Vascular Quiz Five
Terms in this set (179)
Lower Extremity Venous Anatomy and Hemodynamics
Veins have three layers of tissue:
Tunica Intima (Lined with endothelium)
Veins transport blood ___ the heart, carrying cellular ___ products and the gas ___.
to, waste, carbon dioxide
Veins have a ___ tunica media than arteries, so they have ___ walls that collapse with ___ pressure.
thinner, thin, minimal
Veins are highly ___ and ___, with ___ pressure steady flow states.
compliant, distensible, low
A vein with high transmural pressure will have a ___ shape, while a vein with low transmural pressure will have a ___ shape.
Pressure within the veinous lumen is called:
Pressure from outside the vein is called:
The difference between the intraluminal and interstitial pressures is called:
When intraluminal pressure rises, transmural pressure ___, so the vein becomes ___ and ___ circular.
rises, larger, more
Six factors influencing venous return are:
1. Pressure gradient
2. Calf muscle pump
5. Gravity/Hydrostatic Pressure
The pressure between the arterial and venous system differs by ___ mmHg.
The pressure gradient between ___ pressure arterioles and ___ pressure venules causes the blood to flow from the ___ system to the ___ system through the capillary beds.
high, low, arterial, venous
The calf muscle pump is also known as the "___ ___" or the "___ ___".
little heart or venous heart
The calf muscle pump works due to the contraction of the ___ and ___ muscles, which squeeze the blood ___.
soleal, gastrocnemius, forward
The relaxation of the calf muscle pump creates potential ___, blood ___, and low or absent ___.
space, pools, pressure
Venous valves are ___-cuspid elaborations of the tunica ___ that are lined with ___.
bi, intima, endothelium
The ___ extremity valves are more susceptible to disease.
___ valves prevent the backflow of blood.
Incompetent valves are also called ___ ___.
Chronic venous insufficiency may cause ___ venous pressure. This may lead to ___ veins.
Inspiration ___ intrathoracic pressure and ___ intraabdominal pressure, which ___ venous flow in the lower extremities.
decreases, increases, decreases
Expiration ___ intrathoracic pressure and ___ intraabdominal pressure, which ___ venous flow in the lower extremities.
increases, decreases, increases
To perform the ___ ___, the patient takes a deep breath and bears down against a closed glottis.
The Valsalva Maneuver ___ intraabdominal pressure, so flow should slow or cease from the ___ extremities.
If during the Valsalva Maneuver flow increases (augments), venous ___ may be present.
The weight of a column of blood extending to the heart from the point where measured is called:
Hydrostatic pressure supine = ___ mmHg
Hydrostatic pressure walking = ___ mmHg.
Hydrostatic pressure standing = ___ mmHg to ___ mmHg.
80 to 100 mmHg
The accumulation of excessive fluid in intercellular spaces is called ___.
Edema may result from ___ for long periods of time, which ___ pressure in the veinous system of the legs.
The capacity for contraction of the smooth muscle in the tunica media is called ___ ___ .
Venomotor tone is controlled by the ___ nervous system, and works to compensate for circulatory ___.
In a patient who is hemorrhaging, the venomotor tone will force blood out of ___ and into ___.
Five normal Doppler findings for the lower extremity venous system are:
Competence of valves
Flow in the lower extremity venous system should be ___ and ___ immediately.
Lack of flow in the lower extremity venous system indicates ___ or ___ ___.
thrombus, external compression
___ of the flow in the lower extremity venous system is caused by respiration.
___ of the flow in the lower extremity venous system is caused by ___ compression, which causes a rush of blood ___.
Augmentation, distal, superiorly
Waveforms of the flow in the lower extremity venous system should be ___-directional, and should not cross the ___.
Waveforms of the flow in the lower extremity venous system should vary with ___, not ___.
The Central Veins may have waveforms that have both ___ and ___ due to their close proximity to large arteries.
The Deep Digital Veins of the feet join to form the ___ veins, which merge into the ___ ___ veins, the ___ ___ ___ veins, and the ___ ___ ___ veins; these three combine into the ___ vein.
Metatarsal, Paired Peroneal, Paired Posterior Tibial, Paired Anterior Tibial, Popliteal
The Popliteal vein becomes the ___ ___ vein above the knee, which merges with the ___ ___ vein to become the ___ ___ vein.
Superficial Femoral, Deep Femoral, Common Femoral
The Common Femoral Vein becomes the ___ ___ when it crosses the inguinal area. It merges with the ___ ___ vein to become the ___ ___ vein, which combines with the contralateral vein to become the ___ ___ ___.
External Iliac, Internal Iliac, Common Iliac, Inferior Vena Cava
The two Common Iliac Veins join to become the IVC at the level of the ___ Lumbar vertebra.
Deep Veins have an ___ artery and are ___ in the calf.
The two main veins of the superficial lower extremity venous system are:
The Greater Saphenous Vein
The Lesser Saphenous Vein
The Greater Saphenous Vein is also known as the ___ ___ ___, and is abbreviated ___.
Longer Saphenous Vein, GSV
The Lesser Saphenous Vein is also known as the ___ ___ ___, and is abbreviated ___.
Shorter Saphenous Vein, SSV
The ___ is the longest vein in the body, and lies just beneath the skin.
The GSV begins on the ___ of the foot, travels anterior to the ___ ___ and continues medially up the leg to unite with the ___.
dorsum, medial malleolus, CFV
The junction of the GSV and CFV is called the:
SaphenoFemoral Junction (SFJ)
The SSV can be thought of as the "___ ___" vein as it ascends the back of the calf to join with the ___ vein.
Stocking Seam, Popliteal
The junction of the SSV and Popliteal Vein is called the:
SaphenoPopliteal Junction (SPJ)
Junctions between the Superficial and Deep Venous systems are prone to ___, so must be thoroughly checked.
The typical confluence of the SSV is at the Popliteal vein, but in 20-30% of the population, the SSV will enter ___ the popliteal vein or join the ___ vein, a communicant vein between the GSV and SSV.
Are Superficial lower extremity veins paired with an adjacent artery?
No. Only the Deep Veins have paired arteries.
The Greater Saphenous Vein has ___ to ___ valves.
The Lesser Saphenous Vein has ___ to ___ valves.
The Perforator Veins have ___ valve(s) each.
The Popliteal Vein has ___ to ___ valves.
The Superficial Femoral Vein has ___ to ___ valves.
The Common Femoral Vein has ___ valve(s).
The Common Iliac Vein has ___ valve(s).
The Internal Iliac Vein has ___ valve(s).
The External Iliac has a valve ___% of the time.
25% of time
The Jugular Vein has ___ valve(s).
More valves will be located in the ___ veins to deal with increased ___ pressure.
___ veins form channels of communication between the superficial and deep venous systems
Each perforator has a ___, which assures unidirectional flow.
There are several important perforators in the ___ and ___.
Incompetent valves in perforators may lead to ___ ___ ___.
venous stasis ulcers
Venous ___ are spaces that allow blood to accumulate in the calf muscles.
When calf muscles contract they return blood from the venous sinuses to the ___ ___ and ___ veins, so they are of great importance to the function of the Calf Muscle Pump.
Posterior Tibial, Peroneal
The Gastrocnemius muscle's vein feeds into the ___ Vein.
The Soleal veins (there are 2) feed into the ___ ___ and ___ veins.
Posterior Tibialis, Peroneal
Lower Extremity Duplex Scanning and Disease
___ ___ is a group of three risk factors that greatly increase the risk of venous disease.
The three components of Virchow's Triad are:
1. Changes or injury to vein walls (endothelium)
2. Venous stasis
3. Hypercoaguability of blood
Bed rest (>4 days), immobility, myocardial infarction (MI), CHF, COPD, obesity, pregnancy, estrogen intake, previous episodes of DVT, and paraplegia (lower limb paralysis)are all risk factors that cause ___ ___ of the blood.
Pregnancy, cancer treatments, estrogen intake, and Myeloproliferative disorders are all risk factors that cause ___ of the blood.
Trauma and/or surgery cause ___ or ___ of the venous walls.
DVT can either be an ___ or ___ disease.
The four symptoms of acute DVT are:
2. Pain with acute onset
3. Redness or erythema
The five symptoms of chronic DVT are:
3. Brawny discolorations
Muscle strain, a direct injury to the leg, a muscle tear, cellulitis, lymphangitis, or extrinsic compression are all differential diagnoses for what type of DVT?
A Baker's Cyst, CHF, or complications of chronic venous insufficiency are all differential diagnoses for what type of DVT?
Blood clots can occur at any site, but most frequently arise at the ___ ___ of the venous system.
If venous flow is restricted, ___ ___ can result ___ the restriction.
venous hypertension, below
Repeated episodes of DVT may cause damage to the ___ of the veins.
The most serious sequela of DVT is a ___ ___.
Pulmonary emboli occur more frequently as a result of ___ DVT.
There are ___ to ___ million cases of DVT, ___ cases of Pulmonary Embolus, and ___ deaths from PE annually.
1 - 10 million cases of DVT
600,000 cases of Pulmonary Embolus
200,000 deaths from PE
What is more deadly, a large embolus or a small one?
A large embolus- more lung tissue will die.
The five sequela of DVT are:
1. Collateral formation
2. Valvular damage
3. Venous hypertension
4. Varicose veins
5. Skin changes
Repeated episodes of DVT will cause the vein walls to be ___ and the valves to ___.
Valvular damage allows blood to flow ___, leading to venous hypertension, varicose veins, and skin changes.
___ varicose veins are hereditary, and not related to DVT.
Primary varicose veins affect only the ___ veins.
Superficial (Greater and Lesser Saphenous veins)
In Secondary varicose veins, the valves of the ___ and ___ venous system are incompetent.
Secondary varicose veins are related to repeated episodes of DVT, pregnancy, or obesity; these cause ___ to form, which show as the varicose veins.
DVT causes five skin changes:
3. Brawny discoloration in the gaiter zone
4. Phlegmasia alba dolens
5. Phlegmasia cerulea dolens
Edema occurs due to venous ___ resulting from DVT.
Venous hypertension forces fluids out of the veins into surrounding tissue, so ___ areas may be seen under the skin of a patient with edema, known as the ___ Sign.
Brawny discoloration resulting from DVT occurs in the gaitor zone (between the ___ and ___). The leg will be a reddish to brownish color.
Stasis Dermatitis resulting from DVT will cause ___ (skin inflamation), mild ___, and ___ discoloration.
erythema, scaling, brownish
Phlegmasia alba dolens is also known as ___ Leg or ___ Leg.
Phlegmasia alba dolens occurs with arterial spasms secondary to extensive acute ___ DVT, which presents with severe ___ of the leg.
Phlegmasia cerulea dolens occurs when reduced venous ___ reduces arterial ___.
Phlegmasia cerulea dolens leads to tissue hypoxia which causes ___ of the limb. This may lead to venous ___.
Which occurs near the medial malleolus, arterial or venous ulcers?
Which occurs at the Tibial area, toes, and bony prominences, arterial or venous ulcers?
A patient with arterial ulcers will have ___ pain.
A patient with venous ulcers will have ___ pain.
___ ulcers are irregular and shallow, with venous ooze.
___ ulcers are regular and deep, with little bleeding.
A patient with ___ ulcers may also have brawny discoloration and varicosities.
A patient with ___ ulcers will have shiny, hairless skin.
The patient position when Duplex scanning the lower extremity veinous system should be ___ ___ or torso elevated ___ to ___ degrees with the hip ___ rotated.
reversed trendelenberg, 10-20 degrees, externally
The transducer used when Duplex scanning the lower extremity veinous system should be ___ to ___ MHz.
5 to 7 MHz
___ of the vein walls is another way to say compression of the vein.
The vein should be ___ than its corresponding artery unless it is being compressed.
The diagnostic criteria for DVT are absence of vein ___, visualization of a ___, vein ___, abnormal ___ signals, reduced or absent ___ with pressure and reduced or absent ___ filling.
compressibility, thrombus, distension, Doppler, augmentation, color
An acute DVT may be ___ in echogenicity, ___ in texture, will be ___ attached (___ of the ___ Sign), cause expansion of the vessel ___, and have no ___ present.
sonolucent, spongy, loosely (Tail of the Dog Sign), lumen, collaterals
A chronic DVT will have a ___ echogenic thrombus than acute, be ___ attached, vein walls will be ___, the vessel will be ___, and ___ formation will have occurred.
more, well, irregular, smaller, collateral
Three treatment options for DVT are:
1. Medical Therapy
2. Anticoagulant Therapy
3. Surgical Therapy
Medical therapies for DVT try to:
control the risk factors of DVT.
Two drugs used for Anticoagulant therapy of DVT are:
Heparin and Coumadin.
Surgical therapy for DVT involves the placement of a:
Venal Caval interruption device (breaks up or catches emboli to be vacuumed out).
Three other imaging methods used for DVT are:
1. Isotope Venography (uses labeled Fibrinogen)
2. Contrast Venography (aka Phlebography)
3. Lung Perfusion Scan (for Pulmonary Embolism)
Steady, continuous flow on a venous waveform suggests proximal ___ or extrinsic ___.
Normal venous flow has ___ variation.
Venous Reflux Testing
Venous insufficiency causes blood to flow ___ , which leads to ___ distal venous pressure, resulting in a myriad of symptoms.
Primary insufficiency occurs due to the congenital absence of ___ (most common in the ___ venous system).
Secondary insufficiency occurs when the valves are damaged due to previous ___ episodes (most common in the ___ venous system)
Venous insufficiency causes repeated episodes of ___ in the calf, ankle, or foot and chronic swelling of the limb.
___ are palpable distended veins of > 4 mm in diameter.
___ are intradermal venules of 1 mm or less.
Telangiectasias is also known as:
___ veins are dilated subdural veins of 1-4 mm.
Venous ___ presents with pain or cramping similar to that occurring in the arterial system, but will have accompanying ___ of the leg.
Venous hypertension resulting from venous insufficiency also causes ___ ___ of the skin due to blood pooling, and ___ ___ if allowed to continue.
stasis dermatitis, venous ulceration
___ ___ is an inflammatory reaction of a vein under the skin with a clot; usually benign and self limiting.
Superficial thrombophlebitis can be caused by ___, ___ veins, or an ___.
trauma, varicose, infection
The four symptoms of superficial thrombophlebitis are:
3. Localized tenderness
4. Palpable cord or mass
Which is more painful, DVT or superficial thrombophlebitis?
Superficial thrombophlebitis, due to the inflammation.
The patient position for Duplex testing of the deep veins is:
Reverse Trendelenberg (the lower extremities are leveled lower than the head and neck.)
When performing Duplex testing of the deep veins, asking the patient to perform the Valsalva Maneuver allows the sonographer to rule out:
When performing Duplex testing of the deep veins, compressing the limb distal to the transducer allows the sonographer to rule out:
thrombosis (between the transducer and compression).
When performing Duplex testing of the deep veins, compressing the limb proximal to the transducer allows the sonographer to rule out:
If there is venous flow reversal, there will be ___ change under Color Doppler, and the waveform will ___ the baseline.
When reading a venous augmentation waveform, the valves are incompetent if reflux lasts longer than ___.
The GSV should be measured at three levels:
Measure vein diameter at proximal, mid, and distal levels
Prox GSV is found at the:
Mid GSV is found at the:
Distal GSV is found at the:
The GSV should not exceed ___mm at proximal.
The GSV should not exceed ___mm at mid.
The GSV should not exceed ___mm at distal.
The GSV should be evaluated using the same methods as the deep veins, but the augmentation method may be altered to "___" the vein.
When evaluating the perforators, scan the course of the ___ and ___ and follow the perforators. You can also scan the fascia on the ___ & ___ calf.
GSV, LSV. medial, posterior
___ (PPG) is used to evaluate venous valve competency.
The two advantages of PPG are:
1. PPG takes less time to perform than duplex imaging
2. PPG is easier to perform than duplex imaging
The two disadvantages of PPG are:
1. May be indeterminate
2. Positives require other testing
The PPG system uses a small transducer with ___ light emitter and receiver.
When performing PPG testing, a sensor is placed about 10 cm proximal to the ___ ___ of the ankle.
When performing PPG testing, the patient performs ___ to ___ dorsa-flexions and plantar flexions.
When performing PPG testing, an infrared light source emits light, a receiving source (the ___-___) channels the signal to a DC amplifier, and the signal is displayed on a ___ ___ recorder.
photo-detector, strip chart
PPG is used to assess venous ___ time after exercise.
PPG testing is not a true plethysmographic technique, as it measures ___ changes, not ___ changes.
When using PPG, the reflected signal strength is proportional to the ___ of red blood cells present in cutaneous circulation.
AC (Alternating Current) coupling is used to detect ___ changes.
DC (Direct Current ) coupling is used to detect ___ refilling changes.
Normal veins fill well, empty ___, and refill ___ (>___ seconds after exercise).
quickly, slowly, 20sec
Abnormal veins empty ___ and/or refill ___ (<___ seconds).
slowly, quickly, 20sec
If a vein is unable to empty with calf exercise, there is a ___ present.
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