![]() Patency usually is assessed by compression of the vein with the transducer.8 Reflux is detected by flow augmentation maneuvers such as distal compression and release of the thigh and calf or the Valsalva maneuver for only the saphenofemoral junction.8 Automated rapid inflation/deflation cuffs are cumbersome but may be used for this purpose and offer the advantage of a standardized stimulus.1012 Reflux greater than 500 ms is considered pathologic.9,13 Transverse and longitudinal scans combined with continuous scanning are performed in order to provide a clear mapping of the venous system. Measurements from the medial malleolus are not as precise. Their location measured in centimeters from the floor provides a therapeutic guide. Duplicated segments, sites of tributary confluence, and large perforating veins and their deep venous connections are identified. ![]() The veins are scanned by moving the probe vertically up and down along their course. Sensitivity and specificity in detecting reflux are increased in examinations performed with the patient standing rather than when the patient is supine.8,9 Supine examinations for reflux are unacceptable. The ultrasound examination is conducted with the patient standing.9 This position has been found to dilate leg veins maximally and challenges vein valves. A clear graphic notation (mapping) of significant vein diameters, anomalous anatomy, superficial venous aneurysms, perforating veins, presence and extent of reflux should always be recorded during the examination (see Figure 23.1).2,5 Positive for reflux if >0.5 secondĪsses for edema, calcifications, phleoboliths etc.A detailed US duplex study of the normal and pathologic venous anatomy (reflux) is essential. If accessory GSV is incompetent then measure the diameter and the straight length. If patient has anterior, lateral or posterior medial accessory GSVs assess competence. (Giacomini vein cranial extension of SSV that communicates with the GSV via the Note if reflux is coming down from GSV to SSV or from SSV to GSV. When at the SSV check if the Giacomini vein is present and check at mid No incompetent perforators were visualized) Giacomini Vein (Venous insufficiency was noted within the same deep veins and GSV groin to ankle. The Small Saphenous Vein (SSV) did not elicit an incompetent response to distal augmentation. (flow seen above the baseline) Small Saphenous Vein Measuring approximately 4.4mm in A/P diameter w/ approximately over 3 seconds of reflux This incompetent accessory vein was seen as tortuous vessel from the distal thigh to the ankle Note: these are often seen as the “varicose veins” in the calves. Identify an accessory vein (tributaries of the GSV) for incompetence. In this case we measure the entire length (proximal to distal thigh and proximal to distal calf). Measure the diameter of the incompetent GSV areas in transverse. This patient demonstrated severe venous reflux in the GSV from the groin to ankle. The Great Saphenous Vein (GSV) is evaluated next for incompetence. Patient to perform the valsalva technique (this works best from the going to mid to distal thighĪsk if there’s a history of GSV harvesting. You can elicit retrograde flow in the incompentent vein by distal augmentation and/or asking the Measure the wall diameter ( varicose >3mm) of the incompetent perforator vein. Posterior tibial veins along with an incompetent perforator vein in the right leg. ![]() Venous reflux (Valvular incompetence) was then demonstrated in the CFV, the femoral vein, and Reflux in the deep veins is considered spectral reversal >1 second. This patient demonstrates a considerably severe reflux in the SFJ (up to 4 seconds) performed w/ valsalva. Positive reflux is >0.5 seconds for all superficial veins. This should elicit retrograde flow if the SFJ is incompetent. Preform a venous duplex exam protocol, while evaluating for reflux.īegin by evaluating for reflux in the sapheno-femoral junction located in the groin.Īsk the patient to perform the valsalva technique by having them bare down and strain. Prep the patient on the bed in reverse Trendelenburg to increase the hydrostatic pressure in the Venous system (including the perforators). Our purpose now is to identify and evaluate the presence of reflux in the deep and superficial Understanding the patient’s history is important information:Ī history of cancer or chemotherapy/radiation treatment? The symptoms caused by venous hypertension can range depending on the severity of the Towards the lower extremities causing an increased intravascular pressure in the veins knownĪs venous hypertension. Venous insufficiency is caused by the backwards flow of blood in the veins returning downward “Venous reflux” is a common abnormality due to valvular incompetence leading to the condition Today we have a case to evaluate for the presence of “ venous reflux”. ![]()
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