Chapter 19: Vascular Mapping

At what distance should marks be placed along the length of the vein when marking?

2 to 3 cm

What is the most. common configuration of GSV in the thigh?

60% of patients will have a single trunk that runs medially in the thigh, and curves slightly towards the inner thigh and has several large tributaries which empty into the vein before it joins the CFV

Great Saphenous Vein

A superficial vein forming at the level of the medial malleolus; courses along the medial calf and thigh.

Small Saphenous Vein

A superficial vein that courses along the posterior aspect if he terminating into the politeal vein.

Perforating vein

A vein that connects from the superficial venous system to the deep system

Recanalization

A vein that is now patent but had previously been thrombosed.

What are ultrasound information obtained about the superficial venous system that helps surgeons make decisions/ surgical plans?

Competency, sustainable as. bypass conduit, hemodialysis fistula, use for vein material as a patch, document and measure.

To maximize venous pressure and distention, the what position should the patient's limbs be placed when mapping the superficial venous system.

Dependent

Varicosities

Dilated, tortuous superficial veins

Mapping

Evaluating the patency, position, depth, and size of the superficial venous system for use as bypass conduit or other surgical procedures

How many common configurations does the thigh portion of the great saphenous vein have?

Five

Appropriate near-field image optimized techniques.

Focus, transmit zone, frequency (TGCs), color adjustments

What is the correct terminology for the superficial venous system?

Great saphenous vein, small saphenous vein, anterior/posterior accessory to the GSV, and cranial extension of the SSV

Anatomy of upper extremity superficial system.

Includes the cephalic vein, basilic vein, and their branches (medical cubital vein)

What measurements can be taken to ensure that a patient's vessels do not vasoconstrict?

Keep the exam room warm and cover the patient, only exposing the limbs being evaluated.

Because the superficial veins are under low pressure and just under the skin, what type of transducer compression must be used to compress these veins?

Light

What is a vein that penetrates the muscular fascia of the leg and connects the superficial system to the deep system.

Perforating vein

What is the most common configuration of the GSV, "Egyptian Eye"?

Single trunk that runs medially, curves slightly towards inner thigh, has several large tributaries that empty. into the vein before it joins the CFV.

Know possible SSV configuration.

Single vessel, duplication, or even absence of the SSV.

Normal anatomical position of the GSV.

The "Egyptian Eye" is the normal anatomical postion of the GSV, where it forms an oval shaped pattern on ultrasound by the muscular fascia and saphenous fascia.

Definition of the vein of Giacomini, intersaphenous vein, and saphenous compartment.

The vein of Giacomini is a communicating vein between the GSV and the SSV, the intersaphenous vein connects the GSV and SSV, and the compartment refers to the area containing these veins.

Why are the vessels easier to identify at the upper arm?

The vessels are larger and have the least amount of branches

Characteristics that makes a vein suitable for use as bypass conduit.

Thin, smooth walls, complaint, easily compressible, freely moving valves with no evidence of thrombus, normal orientation of vessel (Egyptian eye), and adequate size (>2.0 mm, but closer to 3.0 mm)

Disorders of superficial veins and which ones are contraindications for use as bypass.

Thrombus - contraindication for bypass, but not ablation Varicosities. - can be used as conduit if it is a normal size GSV/SSV varicosed - usable Recanalization - cannot be used as arterial bypass Calcifications - can be used excluding calcified segments

Why does the GSV configuration that makes it difficult for surgeons the pass instruments through?

Tortuous or heavily varicose veins

Keeping the patient warm during a vein mapping procedure helps to reduce peripheral ______________________.

Vasoconstriction

Which of the following characteristics are assessed during preoperative evaluation of the superficial venous system?

Vein patency, Vein depth and size, and vein position

Which of the following describes the proper technique for marking a superficial vein in a longitudinal image orientation?

Vein should fill screen from left to right; transducer should be perpendicular to skin surface

Common source for the AV fistula to develop when GSV is used as in bypass.

When the GSV is used in situ bypass in arterial surgeries.

When mapping and marking superficial veins, what is the transverse orientation useful to help identify?

branch points and vein diameter

Diabetics and patients with end-stage renal disease can often have venous ______________ that may make a vein unsuitable for bypass material.

calcification

When mapping directly onto the patient's skin, limited use of gel will allow easier marking on the skin and reduce the amount of _____________ the patient experiences because of gel evaporation.

cooling

When mapping a vein, two types of branches should be identified: __________ branches and deep ___________ veins.

cutaneous; perforating

When a double saphenous system occurs, it is important to distinguish which system is ____________ so the surgeon can select appropriately.

dominant

When measuring vein diameters for use as a conduit, how should the veins be measured?

inner wall to inner wall

The cephalic vein courses up the _____________ side of the forearm, whereas the basilic vein courses up the _________________ side of the forearm.

lateral; medial

There are several common configurations on the great saphenous vein. Most often, there is a trunk, which runs ________________ in the thigh.

medially

Appropriate system settings for venous mapping include adjusting the transmit power and focal zones for a well-defined _________ field image and adjusting Doppler settings to detect ___________________.

near; low-flow states

When using a superficial vein for in situ arterial bypass, _________________ veins must always be identified and ligated.

perforating

If using a longitudinal approach to vein mapping, the technologist should be sure that the vein completely fills the screen from right to left and that the transducer is _____________ to the skin surface.

perpendicular

The small saphenous vein is typically a single trunk that courses up the middle of the posterior aspect of the calf and terminates into the ______________ vein.

popliteal

Veins presenting with an irregular intimal surface or wall thickening may indicate evidence of __________________.

recanalization

The optimal patient position for mapping of the great saphenous vein is a __________ ____________ with the hip externally rotated and knee flexed.

reverse trendelenberg

When starting to map the great saphenous vein, it can be identified at the ___________________ junction in a transverse orientation using light probe pressure.

saphenofemoral

The main great saphenous vein is typically bounded superficially by the ___________________ and deeply by the ___________________.

saphenous fascia; muscular fascia

Pathology of superficial veins and which ones are contraindications for use as bypass.

superficial veins, such as thrombosis or significant stenosis, can be contraindications for using them as bypass conduits in vascular surgery

Because of how vein diameters are measured, vein sizes are often _________________ when compared to intraoperative measurements.

underestimated

In which part of the arm are the superficial veins easiest to identify?

upper arm

Scanning techniques and patient prep / positioning.

visualize the veins, while patient prep and positioning require the patient to be in a suitable position to access and scan the veins