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US review March 9, 2011

US review March 9, 2011. Rule out DVT. If the vein completely compresses there is no underlying clot. no clot. clot. Linear Array Probe (5-10 mHz). Patient reclines at 45 o Hip externally rotated. Note: SFV – “superficial” femoral vein is a deep vein!. Just 2 key areas to compress.

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US review March 9, 2011

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  1. US reviewMarch 9, 2011

  2. Rule out DVT

  3. If the vein completely compresses there is no underlying clot.

  4. no clot clot

  5. Linear Array Probe (5-10 mHz)

  6. Patient reclines at 45o Hip externally rotated

  7. Note: SFV – “superficial” femoral vein is a deep vein!

  8. Just 2 key areas to compress

  9. Our protocol: 4 compression clips CF-saph bifurcation pop “trifurcation”

  10. A normal exam:

  11. Clip #1 CF-saph

  12. CFV – G. Saphenous Junction

  13. Clip #2 bifurcation

  14. Bifurcation: SFV and DFV

  15. Clip #3 pop

  16. Pop V

  17. Clip #4 “trifurcation”

  18. “trifurcation”: pop divides

  19. Some clots:

  20. DVT in CFV

  21. Clip: partially occlusive DVT

  22. movie: mobile DVT

  23. movie: DVT in CFV

  24. Movie: DVT in pop

  25. Chronic DVTs look different

  26. shrunken fibrotic (hyperechoic) collaterals recanalized Chronic DVT

  27. clip: lymph node

  28. The exam is simple!

  29. Stuff you don’t have to know:

  30. You can skip: the mid-thigh the calf Doppler

  31. mid-thigh: SFV

  32. Calf veins: OK to skip

  33. Calf DVTs - Unreliable to diagnose: < 70% sensitivity - Unclear significance: 75% resolve without treatment

  34. But what if you find a calf DVT? Plan A: anticoagulate Plan B: ASA only. Monitor for extension (Not all calf veins are equally important)

  35. Clip: calf veins

  36. Is Doppler needed? No. Compression is sufficient. Color can sometimes help identify vessels. Doppler can give false normals: eg non-occlusive DVT has normal augmentation.

  37. Doppler flow info: Augmentation: - squeeze the calf and blood rushes past the probe - implies no obstruction between calf and probe Respiratory phasicity: • - flow stops on inhale, goes on exhale • - implies no obstruction up in pelvis

  38. Venous flow (note respirations)

  39. phasic flow and augmentation

  40. What is “duplex”? 2 modalities together: U/S + Doppler

  41. Quiz!

  42. A C B

  43. A C D B

  44. A B

  45. Where on the leg are we?

  46. The End

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