Venous Valvular Insufficiency Testing

Venous pressure in the legs in a supine individual is _____________ mmHg at its highest, whereas it increases to about _____________ mmHg w/ standing, depending on a person's height.

10,100

Valvular reflux times as measured on a spectral Doppler display are typically considered abnormal when greater than how many seconds?

2 seconds

What is the major advantage of using hand compression instead of automatic cuff inflators? A. Reproducibility B. Adaptability to unusual venous segments C. Standardized technique and pressures D. Less technical error

Adaptability to unusual venous segments

What is the landmark to identify the anterior accessory saphenous vein?

Alignment sign

Into which of the following vessels does the small saphenous vein terminate? A. Popliteal v B. Gastrocnemius v C. Distal femoral v D. All of the above

All of the above

Superficial vein at the anterior thigh.

Anterior accessory GSV

Which of the following is aligned with the deep system? A. Anterior accessory saphenous v B. GSV C. Posterior accessory saphenous v D. Small Saphenous v

Anterior accessory saphenous vein

When performing an exam for CVVI, patency and flow characteristics should be documented at all the following locations EXCEPT? A. common femoral v B. femoral v C. popliteal v D. anterior tibial v

Anterior tibial v

A pt presents to the vascular lab w/ visible spider veins. Based on this info, what would this pt's clinical CEAP likely be? A. C0 B. C1 C. C2 D. C3

C1

A pt presents to the vascular lab w/ chronic b/l leg swelling. Upon duplex assessment of the venous system, the deep system was found to be unremarkable, although there was reflux demonstrated in the b/l GSVs. What is most likely CEAP classification for this pt? A. C3EpAsPr B. C2EsApPo C. C3EcAsPro D. C6EpAsPro

C3EpAsPr

Clinical, etiologic, anatomic, and pathophysiologic classification of chronic venous insufficiency.

CEAP

Long-lasting venous valvular or obstructive disorders.

Chronic venous insufficiency

A skin change that results in a cluster of veins and skin changes, usually at the ankle, is?

Corona phelbectatica

Pathologic flow or reflux occurring during _____________ of an automatic cuff when the cuff is distal to the site of insonation. A. Compression B. Decompression C. Application D. None of the above

Decompression

What can the use of tourniquet during venous PPG testing help determine? A. deep vs superficial venous reflux B. GSV vs accessory saphenous v C. venous reflux vs venous thrombosis D. perforating vein reflux

Deep vs superficial venous reflux

Cardiac disease, arterial disease, sympathetic tone, or lipid disoeders are all differential diagnoses for?

Edema

Leg swelling

Edema

Term attributed to the effects of stocking used to compress the leg with intent to compress the veins.

Elastic compression

Before assessing the venous system for insufficiency/reflux, which of the following should be performed? `

Evaluation of the deep venous system for obstruction or thrombosis

What's the "Parana maneuver"?

Force patient to shift weight slightly

Superficial vein in the medial aspect of the lower extremity, thigh, and calf.

GSV

What is the reason for the increase in venous pressure with standing?

Introduction of hydrostatic pressure

Swelling attributed to fat tissue.

Lipedema

What is not a pitfall in measuring reflux?

Low-wall filter settings allowing visualization of low-velocity venous flow.

Swelling attributed to the lymph channels or lymph node disorders.

Lymphedema

Superficial venous segments that are not part of the great and small saphenous systems.

Nonsaphenous veins

Temporary leg swelling at the end of a working day, after prolonged standing, or as result of leg positioning, may represent?

Phelboedema

Graphic presentation of pulses such as changes in volume within an organ or other part of the body such as the lower extremity.

Plethysmography

Superficial vein at the posterior medial thigh

Posterior accessory GSV

After thermal albation of a vein, what do the sonographic findings include?

Potentially sonographically absent, fibrosed, or recanalized veins at different locations along the vein length.

A pt presents to the vascular lab for evaluation of valvular incompetence. A venous PPG exam is performed. The results of the exam show a venous refill time (VRT) of 10.5 seconds w/o the use of a tourniquet and 22 seconds w/ the use of a tourniquet. What do these findings demonstrate? A. Normal findings B. Presence of deep venous reflux C. Presence of superficial venous reflux D. Presence of both deep and superficial reflux

Presence of superficial venous reflux

What is air plethysomography useful for? A. determining deep vs superficial venous thrombosis B. determining deep vs superficial venous reflux C. qualification of deep venous reflux D. quantification of chronic venous insufficiency

Quantification of chronic venous insufficiency

What is the proper used of an automatic cuff compression device?

Rapid inflation from 70-80mmHg of pressure, held for a few seconds and released quickly.

Reverse flow, usually in veins w/ incompetent valves.

Reflux

Using APG, increased ambulatory pressures suggestive of the inability to empty the calf veins owing to poor or nonfunctional calf muscle pump are indicated with the which of the following findings? A. residual volume greater than 20-35% B. low venous volume C. venous filling rate less than 2mL/s D. venous filling time greater than 25 seconds

Residual volume greater than 20-35%

Veins with a diameter less than 3mm.

Reticular veins

Within which of the following positions can a true saphenous vein be determined? A. Deep muscular fascia B. Subdural lipid layer C. Saphenous fascia D. Anterior vascular compartment

Saphenous fascia

A CVVI treatment option which uses a foamed or liquid chemical agent injected directly into the vein is termed?

Sclerotherapy (Chemical ablation)

What is the main purpose for venous photoplethysmography of the lower limb? A. definitive diagnosis of venous reflux B. determination of level of reflux C. screening for the detection of reflux D. screening for venous thrombosis

Screening for the detection of reflux

Superficial vein in the posterior aspect of the calf.

Small saphenous

Which technique should be used to quantify reflux flow patterns? A. B-mode imaging w/ B flow B. Color-flow Doppler C. Spectral Doppler D. Power Doppler

Spectral Doppler

Small clusters of veins near the skin surface that may be red, blue, or purple, measuring between 0.5 and 1 mm; also known as telangiectasias.

Spider veins

To best demonstrate valvular incompetence, which position should the pt be examined in? A. Supine B. Reversed Trendelenburg C. Standing D. Trendelenburg

Standing

What type of pt position is recommended for CVVI evaluation?

Standing

The tributary of the GSV near the saphenofemoral junction that is commonly used as a landmark for the venous ablation catheter is the?

Superficial epigastric v

A popular treatment for CVVI which uses radio frequency or laser energy to close the affected veins is termed?

Thermal ablation

A vein that terminates or empties into another often larger vein.

Tributary veins

Veins that pierce the saphenous fascia and drain into another major vein are known as?

Tributary veins

Veins with a diameter equal to or greater than 3mm.

Varicose veins

Communicating vein between the great and small saphenous veins.

Vein of Giacomini

An invasive diagnostic method to detect venous thrombosis, congenital venous malformations, or valvular function is?

Venography

When using proper compression techniques, abnormal veins proximal to the site of compression would demonstrate ____________ flow during compression with _________________ flow during decompression.

increased; retrograde

Which of the following is an emerging technology that may help w/ guidance of venous access, phlebotomy, and injection sclerotherapy? A. venous photoplethysmography B. near-infrared imaging C. air plethysmography D. radio frequency imaging

near-infrared imagin