Term
| What is the significant time-threshold of reflux on spectral Doppler? |
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Definition
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Term
| Group of three perforators from medial malleolus up almost to midcalf? |
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Definition
| Posterior Tibial Perforators (formerly Cockett's) I: 7 cm above medial malleolus II: 12 cm above medial malleolus III: 18 cm above medial malleolus |
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Term
| Perforator near the knee? |
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Definition
| Paratibial Perforator (formally Boyd's) |
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Term
| Perforators around mid and distal thigh connection GSV to FV? |
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Definition
| Perforators of the Femoral Canal (formally Dodd in distal thigh and Hunterian in proximal/mid thigh) |
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Term
| How big are normal perforators? |
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Definition
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Term
| What causes venous pulsatility? |
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Definition
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Term
| Typically, how big is a perforator that is likely to be to cause significant symptoms? |
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Definition
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Term
| What contains the high pressure of the muscle pump? |
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Definition
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Term
| What single condition cause CVI symptoms? |
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Definition
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Term
| What are the symptoms of CVI? |
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Definition
edema
aching, heaviness, fatigue, "venous claudication"
stasis pigmentation (brawny edema)
induration (lipodermatosclerosis)
stasis ulcer |
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Term
| How does the normally-functioning muscle pump work? |
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Definition
Relaxation of the calf muscles allows blood to fill the deep venous system via arterial inflow through the superficial and distal deep venous system. With prolonged standing, the veins slowly fill up and become distended, allowing the valves to open and eventually increase pressure that is directly related to the height of the column of blood. Contraction of the muscle pump with again empty the veins.
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| Lateral Accessory Saphenous Vein |
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Definition
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Definition
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Definition
| Medial Accessory Saphenous Vein |
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Definition
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Term
| According to the CVI article, varicose veins have an estimated prevalence between __% to __% in the adult population, with a _____ to _____ predomimance of __ to __. |
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Definition
| 5% to 30%, female to male, 3 to 1 |
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Term
| According to the CVI article, what are the risk factors found to be associated with CVI? |
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Definition
| age, sex, family history of varixose veins, obesity, pregnancy, phlebitis, and previous leg injury |
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Term
| According tothe CVI article, the more serious consequences of CVI such as venous ulcers have an estimated prevalence of ~0.3%, although active or healed ulcers are seen in about ~__% of the adult population. |
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Definition
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Term
| According to the CVI article, the overall prognosis of venous ulcers is _____, with delayed healing and recurrent ulceration being _____. More than __% of venous ulcers require _____ therapy lasting _____. |
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Definition
| poor, common, 50%, >1 year |
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Term
| According to the CVI article, what is the normal ambulating venous pressure in the lower extremities and why? |
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Definition
| Immediately after ambulation, the pressure within the veins of the lower extremity is normally low (15 to 30mm/Hg) because the venous system has been emptied by the muscle pump. |
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Term
| According to the CVI article, unabated venous hypertension may result in? |
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Definition
| Dermal changes with hypergigmentation, subcutaneous tissue fibrosis ("lipodermatosclerosis"), and eventual ulceration. |
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Term
| What is the primary cause of venous reflux? |
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Definition
| Incompedent venous valves |
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Term
| According to the CVI article, what problem causes increased venous pressure with muscle contraction a secondary muscle pump disfunction? |
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Definition
| Venous outflow obstruction, DVT |
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Term
| According to the CVI article, what are the major clinical features of CVI? |
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Definition
| Dilated veins, edema, leg pain, and cutaneous chages |
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Term
| According to the CVI article, what presumably produces the pain by increasing intracompartmental and subcutaneous volume and pressure? |
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Definition
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Term
| According to the CVI article, what may lead to venous claudication? |
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Definition
| Obstruction of the deep venous system |
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Term
| According to the CVI article, what is primary and secondary CVI? |
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Definition
| Primary CVI is that that is present at birth, although they may be recognized later in life. Secondary is the result of an acquired condition. |
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Term
| For the PPG evaluation of venous refill time, what is considered normal? |
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Definition
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Term
| For APG evalution of venous outflow, the tracing should fall to the baseline in what amount of time after high thigh cuff deflation to be considered normal? |
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Definition
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Term
| According to the CVI article, what is sclerotherapy and what is it used for? |
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Definition
| A treatment modality of detergent injection for obliterating telangiectases (spider veins), varicose veins, and venous segments with reflux . May be used as a primary treatment or in conjunction with surgical procedures in the correction of CVI. |
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Term
| What are the GSV diameters compatible with incompetence at the levels of the SFJ, mid thigh, and mid calf? |
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Definition
SFJ >9 mm
mid thigh >7 mm
mid calf >5 mm |
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Term
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Definition
| Chronic venous insufficiency: a condition characterized by changes that take place in the tissues of the leg secondary to long-standing venous hypertension caused by structural or functional abnormalities in the veins and/or venous valves. |
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Term
| What is the most common sequelae to symptomatic DVT? |
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Definition
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Term
| What is the clinical hallmark of CVI? |
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Definition
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Term
| What is normal standing venous pressure? |
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Definition
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Term
| Define junctional valve failure: |
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Definition
| Incompetence of the primary valve at the junction of the CFV and the GSV at the site called the SFJ. |
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Term
| Define perforator valve failure: |
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Definition
| Without normal check-valves, higher pressure from the deep system transmits into the superficial system via incompetent perforators. |
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Term
| What are the symptoms of Raynaud's Disease? |
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Definition
| During a typical Raynauds' attack the affected area may first become white (pallor) as the blood suppy is reduced, then blue (cyanosis) as the oxygen supply to the area is depleted, followed by bright red (rubor) as the blood returns to the area (reactive hyperemia). By definition, Raynaud's involves three color changes. However, they do not always occur in the same order for all people all of the time nor do all three changes always occur in a given attack. |
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Term
| What is TOS? What are the 3 types? |
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Definition
Thoracic outlet syndrome
1. neural (80%)
2. arterial (15%)
3. venous (5%) |
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Term
| What are the 3 manuvers used for TOS evaluation and how are they performed? |
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Definition
- Adson maneuver: head to the left and right (with deep breath, leaning the head back as someone standing behind you calling your name.)
- Costoclavicular maneuver: shrug shoulders back into exaggerated military posture.
- 90° and 180º hyperabduction
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Term
| What is an arteriovenous fistula? |
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Definition
| Abnormal communication between artery and vein. |
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Term
| What are the Doppler findings in an AV fistula? |
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Definition
Flow in fistula: very high velocity, turbulence
Flow and pressure in distal artery: reduced
Flow in proximal artery: very high diastolic component
Flow in proximal vein: very high velocity
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Definition
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Definition
| Internal pudendal artery (branch off the internal iliac artery feeding dorsal penile, deep cavernosal, and urethral arteries) |
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Definition
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Term
| What are some possible causes of penile dysfunction |
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Definition
1. Inadequate inflow due to atherosclerotic disease, thrombosis, trauma, etc.
2. Venous leakage due to defective veno-occlusive mechanism
3. Ateriovenous shunt
4. Psychogenic, neurologic, endocrine, or structural causes
5. Pharmacological causes: side effects of medications such as hypertensive meds |
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Term
| What is IMT and what is it used for? |
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Definition
| Intima-media thickness. It is used as an indicator of cardiovascular disease risk. |
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Term
| What are some risk factors for elevated IMT? |
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Definition
1. Age
2. Smoking
3. Dyslipidemia
4. Hypertension
5. Genetic predisposition
6. Gender (Male > Females)
7. Race
8. Obesity
9. Diabetes
10. Radiation therapy |
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Term
| What is the purpose of a graft? |
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Definition
| To go around arterial obstruction or repair aneurysm. Many lower-extremity grafts are an effor to save a diabetic foot. |
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Term
| Name some sites for grafts |
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Definition
| aortoiliac, femorofemeoral, femorotibial, iliofemoral, axillofemoral, femoroperoneal, aortofemoral, femoropopliteal, popliteal-tibial, subclavian-carotid, superficial temporal to middle cerebral, ect. |
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Term
| What are some materials used for grafts? |
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Definition
| Gortex, Polytetrafluoroethylene (PTFE) |
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Term
| What are some vein grafts? |
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Definition
| In situ greater saph, reversed greater saph, lesser saph, cephalic, basilic |
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Term
| What is the tool used to strip valves in an in situ vein graph? |
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Definition
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Term
| What are some types of anastomoses? |
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Definition
| end to side, end to end, side to side |
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Term
| What is a problematical flow rate at an anastomotic site? |
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Definition
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Term
| Where is the usual site of first trouble in a graft? |
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Definition
Distal anastomosis, possibly due to turbulence and slower flow
Other problem sites: venous vlaves, inflow disease, outflow disease, graft aneurysm, neointimal proliferation, kinks and tortuosities |
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Term
| What is the radial-cephalic avf called? |
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Definition
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Term
| What is an autogenous access graft and what are some common area? |
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Definition
A synthetic (usually PTFE) graft that bridges the gap between the artery and vein.
Forearm loop from brachial artery to basilic or median cubital vein.
Upper arm loop from brachial artery to axilllary vein.
Straight graft from radial artery in forearm to basilic vein near antecubital fossa.
Straight graft from brachial artery to antecubital fossa to basilic vein near axilla. |
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Term
| Over time, what could be some problems with an AVF? |
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Definition
- > 80% of graft stenoses occur at the venous anastomotic site
- Venous anastomic stenosis results in graft HTN and ultimately graft thrombosis
- Intrinsic narrowing or stenosis can occur anywhere along the graft or venous oultlow tract
- Upper extremity cntral venous obstuction or occlusion has an incidence between 10-40%
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Term
| What is the blood flow velocity threshold that signifies AVF failure? |
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Definition
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