Ultrasound Examination

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In 2002, an International Interdisciplinary Consensus on Venous Anatomical Terminology proposed a revision and extension of the Terminologia Anatomica of the lower extremity venous system (see Table 18.2).19 The new nomenclature has been fully adopted in this chapter.

The ultrasound examination is carried out with the patient standing in an upright position.20 This position elicits reflux by challenging venous valves and maximally dilates the leg veins. Sensitivity and specificity in detecting reflux are increased in examinations performed with the patient standing rather than when the patient is supine.7,8,20 The supine examination should be considered to be inadequate.

Medical Term Ankle Bone

FIGURE 18.1 This data entry form outlines the saphenous veins and the relevant deep veins. Refluxing veins are added in heavy black lines. Location of perforating veins and aneurysms can be added and distance from the floor indicated. Diameters of perforating veins at the fascial level should also be noted.

FIGURE 18.1 This data entry form outlines the saphenous veins and the relevant deep veins. Refluxing veins are added in heavy black lines. Location of perforating veins and aneurysms can be added and distance from the floor indicated. Diameters of perforating veins at the fascial level should also be noted.

Of particular importance is instruction to the patient to inform the ultrasonographer of any lightheadness, faint feeling, dizziness, or nausea. These symptoms seem to be associated with the overall atmosphere of the room and the audibility of Doppler velocity signals. The symptoms appear less frequently in patients when the examination is performed silently. If such a tendency to fainting because of vaso-vagal reflux is encountered, the examination may need to be modified with the patient in the semi-upright position.14

The veins are scanned by moving the probe vertically up and down along their course. Duplicated segments, sites of tributary confluence, and large perforating veins and their deep venous connections are identified.14

Transverse rather than longitudinal scans, and continuous scanning are performed in order to provide a clear mapping of the venous system.14 This can be recorded on a premade datasheet (see Figure 18.1). Patency usually is assessed by compression of the vein, and reflux is detected on release. The augmentation of flow, distal compression, and release of thigh and calf6 should be done sharply and quickly.14 Automated rapid inflation/deflation cuffs are cumbersome but may be used for this purpose, and offer the advantage of a standardized stimulus.815 The Valsalva maneuver is a reverse flow augmentation stimulus and is used only for the Sapheno-femoral junction (SFJ) because a competent valve will render the test useless distally.

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