RPhS flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

Reflux time threshold, superficial veins

Retrograde flow lasting longer than 0.5 seconds in the great or small saphenous vein during Valsalva or distal augmentation is the standard criterion for superficial venous incompetence.

Reflux threshold, perforating veins

Outward (deep-to-superficial) flow through a perforating vein lasting longer than 0.5 seconds indicates incompetence; many laboratories also require a diameter of at least 3.5 mm.

Saphenofemoral junction location

The junction where the great saphenous vein joins the common femoral vein, located at the fossa ovalis, roughly 2 to 4 cm below and lateral to the pubic tubercle.

Small saphenous vein junction

The small saphenous vein usually joins the popliteal vein in the popliteal fossa, but its termination level varies and may lie above or below the knee crease.

Primary DVT criterion

Lack of complete vein compression by the transducer is the principal sonographic sign of deep vein thrombosis; color filling alone does not exclude a partially occlusive thrombus.

Phasic venous flow

Normal venous Doppler flow varies with respiration because intrathoracic and intra-abdominal pressure change; loss of phasicity suggests proximal obstruction or altered hemodynamics.

Valsalva maneuver in venous exam

A forced expiration against a closed glottis raises intra-abdominal pressure and reverses flow in incompetent proximal veins; it is used to test the common femoral and saphenous junctions.

Augmentation test

Manual compression of the calf or foot distal to the sample volume, then sudden release, should produce a brief increase in venous velocity; absent augmentation suggests obstruction between the sample and the compression site.

CEAP clinical classes

C0 no visible signs, C1 telangiectasia or reticular veins, C2 varicose veins, C3 edema, C4 skin changes, C5 healed ulcer, C6 active ulceration.

EHIT grading

Endovenous heat-induced thrombosis is graded I to IV by thrombus extent: I near the junction, II into the deep vein, III up to one-third, IV more than one-third or occlusive in the deep vein.

Saphenous compartment sign

The great saphenous vein lies between the saphenous fascia and the muscular fascia, producing the 'saphenous eye' appearance on transverse imaging that distinguishes it from superficial tributaries.

Reverse Trendelenburg position

Tilting the patient head-up about 15 to 30 degrees distends lower-limb veins and reduces artifact from underfilling, which aids reflux and diameter measurement.

Deep vein reflux threshold

In the deep veins of the leg, retrograde flow longer than 1.0 second is often used to define reflux; in the common femoral vein some standards accept 0.5 seconds, so report the criterion applied.

Transducer choice for venous exam

A linear array transducer of 5 to 12 MHz is typical for superficial and most leg veins; a lower-frequency curved probe is used for obese patients or deep calf and iliac veins.

Color Doppler settings

Set the velocity scale low enough to detect slow venous flow, and use a small color box with an appropriate wall filter; excessive scale or gain can hide low-velocity venous signal.

Sample volume placement

Place the Doppler sample volume in the center of the vessel lumen with an insonation angle of 60 degrees or less; a steep angle overestimates velocity and degrades waveform quality.

Great saphenous vein diameter criterion

A diameter of 3 mm or more, measured at the junction and 3 cm distal to it, is commonly reported as consistent with incompetence, but it must be paired with reflux on Doppler.

Post-thrombotic syndrome signs

Chronic venous obstruction and valve damage after DVT produce edema, hyperpigmentation, lipodermatosclerosis, and ulceration; ultrasound may show residual thrombus, wall thickening, and reflux.

Venous valve location

Bicuspid venous valves occur throughout the deep and superficial systems, most numerous below the knee; the great saphenous has a terminal valve at the junction and a preterminal valve just below it.

Compression ultrasound protocol, DVT

Assess common femoral, femoral, deep femoral, popliteal, and calf veins; compress transversely every 1 to 2 cm and document compressibility, color fill, phasicity, and augmentation at each site.

Popliteal vein imaging approach

Image the popliteal vein posteriorly with the patient prone or the leg externally rotated; the vein lies superficial to the popliteal artery and is compressed against the femoral condyle region.

Calf vein thrombosis

Isolated calf vein thrombosis involves the paired peroneal, posterior tibial, and anterior tibial veins and the soleal and gastrocnemius muscular veins; isolated muscular vein thrombosis may be managed differently.

Venous ulcer location

Venous ulcers typically occur in the gaiter area above the medial malleolus with surrounding skin changes; arterial ulcers occur at pressure points and toes, and mixed disease requires arterial assessment before compression.

Ankle-brachial index before compression

An ABI below 0.9 suggests arterial disease and warrants caution with compression therapy; venous studies should note any arterial insufficiency because treatment plans depend on it.

Recanalization versus rethrombosis

Recanalized chronic thrombus appears echogenic, irregular, and adherent to the wall with partial compressibility; acute thrombus is hypoechoic, distends the vein, and is less compressible.

Iliac vein evaluation

The external iliac vein is assessed with a lower-frequency probe, often through the abdomen with the patient supine; phasicity and response to Valsalva help detect iliac obstruction.

May-Thurner anatomy

The left common iliac vein is compressed between the right common iliac artery and the spine, predisposing to left-sided iliofemoral thrombosis; ultrasound may show flow abnormality but CT or venography confirms it.

Superficial thrombophlebitis imaging

Superficial vein thrombosis appears as a noncompressible, echogenic, tender cord; measure its distance from the saphenofemoral or saphenopopliteal junction because proximity affects anticoagulation decisions.

Venous malformation on ultrasound

Slow-flow venous malformations appear as compressible, hypoechoic spaces with low-velocity monophasic flow and phleboliths; absence of arterial flow distinguishes them from arteriovenous malformations.

Tourniquet test

A proximal tourniquet that distends distal superficial veins while the deep system remains unchanged helps confirm that varicosities arise from superficial rather than deep reflux.

Documentation of reflux

Record the vein segment, duration of retrograde flow in seconds, provocation method, patient position, and vessel diameter; this supports mapping and procedure planning.

Venous insufficiency versus obstruction

Reflux produces a reversed, prolonged waveform after provocation; obstruction produces continuous or diminished flow, loss of phasicity, and poor augmentation, and both may coexist.