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Nuklearmedicinsk Afdeling Odense Universitetshospital

Nuklearmedicinsk Afdeling Odense Universitetshospital. Navn:_________________ CPR.nr.:_______-____. Ultralydsscanning med henblik på venøsinsufficiens. Undersøger:__________. Dato:________. Dybe vener. Insufficiens (markeres med X). Højre Venstre. V. femoralis sup. □ □

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Nuklearmedicinsk Afdeling Odense Universitetshospital

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  1. Nuklearmedicinsk Afdeling Odense Universitetshospital Navn:_________________ CPR.nr.:_______-____ Ultralydsscanning med henblik på venøsinsufficiens Undersøger:__________ Dato:________ Dybe vener Insufficiens (markeres med X) Højre Venstre V. femoralis sup. □□ V. poplitea (prox/distalt) □ / □ □ / □ Ja/Nej Ja/Nej Åbne dybe crusvener □ / □ □ / □ Højre Venstre Markering: sort = okkluderet; rød = venøs insufficiens Superficielle vener Beliggenhed af insufficiente perforanter Anteriort Posteriort Højre Venstre Femur (cm over knæ) Crus (cm over hæl) V. saphena magna: V. saphena parva: Højre Venstre Venstre Højre Insufficiens (markeres med X) Højre Venstre V. saphena magna (indløb/femur/crus) □ / □ / □ □ / □ / □ V. saphena parva (indløb/prox/distalt) □ / □ / □ □ / □ / □

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